Key result
Coronary vein LV pacing yields ~96% 3-year lead stability with complications similar to RVP.
Why the study?
Conventional right ventricular pacing can cause tricuspid valve injury or dysfunction by crossing the valve, which may be especially problematic in patients with preexisting tricuspid valve disease or prior surgery.
Does left ventricular pacing via coronary veins improve lead stability and prevent worsening of tricuspid regurgitation compared to conventional right ventricular pacing in patients with preexisting tricuspid valve disease?
Cohort (n=52)
No
Does left ventricular pacing via coronary veins improve lead stability and prevent worsening of tricuspid regurgitation compared to conventional right ventricular pacing in patients with preexisting tricuspid valve disease?
Left ventricular pacing via the coronary veins is a feasible and safe alternative to right ventricular pacing in patients with preexisting tricuspid valve disease, offering stable lead parameters and potentially avoiding pacing-induced worsening of tricuspid regurgitation.
Supports LV pacing stability in tricuspid valve disease; leaves open effects on regurgitation and requires randomized trials.
BACKGROUND: Conventional right ventricular (RV) pacing is increasingly recognised to cause tricuspid valve (TV) injury or dysfunction, in part due to the need to pass the lead through the valve. This may be especially problematic in patients with preexisting TV disease or prior TV surgery. An alternative in this situation is to implant a left ventricular (LV) lead instead of ventricular pacing. METHODS: We performed a single-center retrospective analysis of 26 patients with tricuspid valve surgery/disease who received a LV pacing lead in the coronary veins to avoid crossing the tricuspid valve, with or without a right atrial lead. A matched control population was obtained from patients receiving conventional right ventricular pacing and outcomes were compared. Main outcomes of interest were lead stability, electrical lead parameters and change in echocardiographic parameters such as left ventricular ejection fraction (LVEF) during long-term follow-up. RESULTS: Successful left ventricular pacing was established in 25 out of the 26 cases with one case converted to a RV lead due to lead dislodgement. During the 2.96 ± 1.0 year follow-up, 24 of 25 (96.0%) leads were functional with stable pacing and sensing parameters, and 1 of 25 (4.0%) was extracted for due to device infection following an episode of thrombophlebitis. CONCLUSION: We conclude that in patients with existing tricuspid valve disease or surgery, ventricular pacing via the coronary veins is a feasible, safe, and reliable alternative to right ventricular pacing.
No takes yet. Share an insight, caveat, or question.
Li et al. (2019) conducted a cohort in Tricuspid valve disease or prior tricuspid valve surgery (n=52). Left ventricular pacing via coronary veins vs. Conventional right ventricular pacing was evaluated on Lead stability over time. Left ventricular pacing via the coronary veins demonstrated 96.0% long-term lead stability over 3 years in patients with preexisting tricuspid valve disease, with no significant difference in lead complications compared to right ventricular pacing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: