1. INTRODUCTION
Multiple congenital heart diseases have progressive conduction disorders, either intrinsic or developed through reparative surgeries.1 In particular, univentricular hearts are more associated with bradyarrhythmias and complete heart block. Many of these patients need a permanent pacemaker.2 In univentricular hearts, epicardial pacing has been the first option because of the limited venous access. Also, in the presence of intracardiac shunts, it is the preferred method since there is an increased risk of systemic thromboembolism with the endocardial route.1-3 However, epicardial leads have considerable disadvantages. One of them is that they have higher chronic pacing thresholds and reduced generator longevity, although this may be improved with the usage of steroid-eluting epicardial leads. Another problem is invasive surgeries used for implanting these leads.4,5 The present report explains the implantation of a permanent endocardial pacemaker in an adult patient with tricuspid atresia type IIc with severe pulmonary hypertension and complete heart block.