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 Transposition of great arteries can be surgically treated with senning procedure. Atrioventricular block is recognized as a late complication of this surgery. Many patients eventually undergo pacemaker implantation even though transvenous approach might be difficult and complex due to abnormal anatomy. This article describes the case of a 24-year-old patient who was referred to Tehran Heart Center complaining from fatigue, dyspnea, palpitation, and dizziness. At one year of age he had undergone a senning procedure and a few years later a ventricular single lead pacemaker was epicardially implanted for him due to complete heart block. Clinical evaluation revealed A-V dyssynchrony and pacemaker syndrome, so we decided to change the peacemaker to transvenous dual-chamber device. After evaluating the risk of embolization and assessing the venous anatomy, atrial and ventricular leads were successfully implanted. Pacemaker function was normal and no complications were observed in the patient who was free of symptoms during the follow-up period. According to our experience, in such circumstances, if assessment of risk factors indicates that endocardial lead fixation is feasible, it will be the best approach for pacemaker implantation.

Keywords: senning, transposition of great arteries, pacemaker, endocardial lead

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