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Background: Fontan surgery, a palliative procedure for single ventricle patients, often leads to the need for permanent pacing. Epicardial pacing has limitations, while transvenous pacing carries risks in the Fontan circulation. This case series introduces a novel approach of leadless pacemaker implantation in the extra‐cardiac Fontan (ECF) cohort to overcome these limitations. Methods: The study includes four cases of leadless pacemaker (Micra™) implantation in patients with ECF. Procedures were performed under general anesthesia with guidance from trans‐esophageal echocardiography. Various access routes were used, including trans‐carotid and trans‐fenestration approaches. Procedural details, parameters, and follow‐up data were collected. Results: All leadless pacemaker implantations were successful, with satisfactory electrical parameters and stable pacing postprocedural outcomes during short‐term follow‐up. One patient required closure of their fenestration for symptomatic desaturation post procedurally. Conclusions: Leadless pacemaker implantation via trans‐carotid and trans‐fenestration approaches appears to be a feasible back up option for pacing in Fontan patients where other options have been exhausted or there is a patient choice to avoid surgery. These techniques provide an option to avoid leaded systems or epicardial pacing, reducing the need for multiple thoracotomies and addressing challenges associated with surgical pacing leads. Further studies are needed to evaluate long‐term outcomes and assess the broader application of leadless pacemakers in the Fontan population. [ABSTRACT FROM AUTHOR]

Coarctation of the aorta (CoA) accounts for approximately 5–8% of all congenital heart defects. Depending on the severity of the CoA and the presence of associated cardiac lesions, the clinical presentation and age vary. Developments in diagnosis and management have improved outcomes in this patient population. Even after timely repair, it is important to regularly screen for hypertension. Patients with CoA require lifelong follow-up with a congenital heart disease specialist as these patients may develop recoarctation and complications at the repair site and remain at enhanced cardiovascular risk throughout their lifetime. [ABSTRACT FROM AUTHOR]