Key result
Middle cardiac vein RV lead placement succeeds without complications in two hostile tricuspid valve patients.
Why the study?
RV lead placement can be contraindicated after TV surgery, making MCV lead placement a potential alternative for patients requiring a BiV ICD.
Is middle cardiac vein lead placement a viable alternative for biventricular ICD implantation in patients with hostile tricuspid valve anatomy?
Case Report (n=2)
Is middle cardiac vein lead placement a viable alternative for biventricular ICD implantation in patients with hostile tricuspid valve anatomy?
Placing the right ventricular lead in the middle cardiac vein is a safe and effective alternative for biventricular ICD implantation in patients with hostile tricuspid valve anatomy.
Hypothesis-generating for middle cardiac vein RV lead placement in hostile tricuspid anatomy; prospective validation required before clinical adoption.
AIMS: Right ventricular (RV) lead placement can be contraindicated in patients after tricuspid valve (TV) surgery. Placement of the implantable cardiac-defibrillator (ICD) lead in the middle cardiac vein (MCV) can be a viable option in these patients who have an indication for biventricular (BiV) ICD. We aim to describe the case of two patients with MCV lead placement and provide a comprehensive review of patients with complex TV pathology and indications for RV lead placement. METHODS AND RESULTS: We describe the cases of two patients with TV pathology unsuitable for the standard transvenous or surgical RV lead placement and undergoing BiV ICD implantation. Their characteristics, procedure, and outcomes are summarized. The BiV ICD was successfully placed with the RV lead positioned in the MCV in both patients. The procedures had no complications and were well-tolerated. On follow-up, both patients had appropriate tachytherapy with no readmissions for heart failure or worsening of cardiac function. CONCLUSION: Right ventricular lead placement of BiV ICD in the MCV can be an excellent alternative in patients with significant TV pathology and poor surgical candidacy.
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Maskoun et al. (2020) conducted a case report in Hostile tricuspid valve anatomy requiring biventricular ICD (n=2). Right ventricular lead placement in the middle cardiac vein (MCV) was evaluated on Procedural success, complications, and follow-up outcomes. Right ventricular lead placement of a biventricular ICD in the middle cardiac vein was successfully performed without complications in two patients with hostile tricuspid valve anatomy.
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