A Novel Approach to Transvenous Dual‐Chamber Pacing Lead Placement and Cardiac Defibrillator Implantation After Tricuspid Valve Replacement

Abstract

Pacing and Defibrillation Therapy. We report the successful use of a percutaneous, totally transvenous endocardial approach to atrioventricular pacing and internal cardiac defibrillation in an adult patient with tetralogy of Fallot who had undergone three previous cardiac operations, including a tricuspid valve replacement. Ventricular pacing and sensing were achieved with a bipolar lead in the lateral cardiac vein, and atrial pacing was attained in the region of Bachmann's bundle. Internal defibrillation was achieved with a coil lead in the middle cardiac vein and an "active can" pulse generator in the retromammary position. This minimally invasive method has significant potential benefits because it avoids epicardial placement via a thoracotomy and allows endocardial placement without crossing the tricuspid valve.

Contemporary Outcomes of Operations for Tricuspid Valve Infective Endocarditis

“…Transvalvular pacing wires can result in leaflet perforation, valve damage, and valve dysfunction [20]. A fibrotic response results from contact of the lead against leaflet tissue and the subvalvular apparatus [21].…”

Implantable cardioverter defibrillator lead placement in the middle cardiac vein after tricuspid valve surgery

“…Providing permanent pacing and transvenous cardiac defibrillation for patients with previous tricuspid valve surgery is a difficult task, but the excellent results from the long-term follow-up in these six patients 8,10,11 demonstrate that defibrillator coil lead placement in the MCV is a safe alternative in patients for whom RV lead placement is either contraindicated or impossible.…”

“…The technique has been described in detail elsewhere. 8 Briefly, after patients were under conscious sedation, a left axillary venous approach was used to catheterize the coronary sinus (CS). Angiography of the CS was performed with balloon occlusion either as distal as possible or in the anterior cardiac vein to document the middle cardiac vein (MCV) (by antegrade contrast flow) and its relationship to the proximal CS (Figure 1).…”

Complete Epicardial Resynchronization Device Implantation in a Patient Who Underwent a Replacement of Mitral and Tricuspid Valve

“…But in this case, the device implantation was not performed at the time of surgical intervention. Another report by the same group described another technique of implantation in a patient with corrected tetralogy of Fallot by positioning the ventricular pacing/sensing lead in the lateral cardiac vein, atrial pacing in the region of Bachmann's bundle, and internal defibrillation achieved with a coil lead in the middle cardiac vein and an active can pulse generator in the retromammary position …”