Pacing in the Middle Cardiac Vein in a Patient with Tricuspid Prosthesis

Abstract

A man with acute endocarditis developed complete heart block several days after the tricuspid and aortic valve replacement. Several weeks after implantation, his epimyocardial pacing leads developed a high threshold and failed to capture the ventricle at the maximal pulse width and output of the pacemaker. An angled-tip lead was placed in the middle cardiac vein for ventricular pacing. The pacing and sensing thresholds of this lead were within the expected range during follow-up. Therefore, in patients with prosthetic tricuspid valve, pacing in the middle cardiac vein should be considered before open-chest placement of the epimyocardial lead.

Bioprosthetic Tricuspid Valve Regurgitation Associated With Pacemaker or Defibrillator Lead Implantation

“…Epicardial leads generally have poorer longevity compared with endocardial leads due to higher chronic thresholds (i.e., exit block) and lead fracture (12), whereas the long-term stability of leads placed via the coronary sinus is less than that of leads placed in a conventional endocardial RV location (14,15). A transvenous endocardial system may even be placed before TVR and then exteriorized to the prosthesis at the time of TVR.…”

Anatomy of the Coronary Sinus and Epicardial Coronary Venous System in 620 Hearts: An Electrophysiology Perspective

“…A detailed appreciation of the coronary venous anatomy has become increasingly relevant in contemporary electrophysiology 1–4 . In addition, radiofrequency ablation procedures for epicardial left‐sided accessory pathways and as part of complex atrial fibrillation ablation also require negotiation of the coronary venous system.…”

Transvenous Cardioverter‐Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis

“…Sporadic cases have been reported in literature: ventricular pacing and sensing may be accomplished epicardially either via a coronary sinus branch (transvenously) 1–5 . or via a limited thoracotomy 5,6 .…”

“…Sporadic cases have been reported in literature: ventricular pacing and sensing may be accomplished epicardially either via a coronary sinus branch (transvenously). [1][2][3][4][5] or via a limited thoracotomy. 5,6 This latter approach carries higher risks in previously operated-on patients, and usually has a higher long-term pacing threshold.…”

“…[1][2][3][4][5] or via a limited thoracotomy. 5,6 This latter approach carries higher risks in previously operated-on patients, and usually has a higher long-term pacing threshold. 5,6 The availability of leads dedicated to ventricular stimulation via the coronary sinus branches has made a fully transvenous approach reliable, with very satisfactory results in long term.…”