Coronary sinus single-site pacing in patients with tricuspid valve disease showed similar lead revision or abandonment rates to right ventricular pacing (HR 0.87; 95% CI 0.03-22.0).
Cohort (n=23)
Does coronary sinus single-site left ventricular pacing provide stable lead parameters and preserve LVEF compared to conventional right ventricular pacing in patients with tricuspid valve disease?
Single-site ventricular pacing via the coronary sinus is a feasible, safe, and reliable alternative to right ventricular pacing in patients with normal LVEF and tricuspid valve disease.
Effect estimate: HR 0.87 (95% CI 0.03-22.0)
Aims: To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated. Methods and results: We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CSSS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CSSS leads, the lead revision/abandonment was similar with RVSS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CSCRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049). Conclusion: In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.
Noheria et al. (Wed,) conducted a cohort in Tricuspid valve disease with normal LVEF (n=23). Coronary sinus single-site (CSSS) left ventricular pacing vs. Conventional right ventricular single-site (RVSS) leads and coronary sinus leads for cardiac resynchronization therapy (CSCRT) was evaluated on Lead revision/abandonment (HR 0.87, 95% CI 0.03-22.0). Coronary sinus single-site pacing in patients with tricuspid valve disease showed similar lead revision or abandonment rates to right ventricular pacing (HR 0.87; 95% CI 0.03-22.0).