Permanent pacing via coronary sinus after tricuspid valve replacement: Keep bipolar coronary sinus leads on hand

Background Conduction disturbances requiring permanent pacemaker (PPM) implantation are frequent after tricuspid valve replacement (TVR). Conventional transvalvular right ventricular pacing risks prosthetic valve dysfunction, while epicardial pacing is limited by surgical complexity, high thresholds, and reduced lead durability. Coronary sinus (CS) pacing offers a potential alternative, but data after TVR remain limited. Methods We retrospectively analyzed eight patients who underwent PPM implantation via the CS following TVR at our center. Demographics, procedural details, and pacing parameters were collected. Electrical performance (pacing threshold, lead impedance, pacing percentage) was assessed during follow-up. Results PPM implantation via CS was successfully performed in all patients (median age, 61 years; 87.5% female), with seven undergoing bioprosthetic and one undergoing mechanical TVR. The median time from surgery to implantation was 7 days. Mean procedure and fluoroscopy times were 66.5 ± 25.2 and 13.3 ± 6.8 minutes, respectively. No acute or peri-procedural complications occurred. Over a median follow-up of 20.5 months, pacing thresholds and lead impedance remained stable (median threshold 1.5 V, IQR 1.0–2.25; median impedance 846 Ω, IQR 470–979), with a median ventricular pacing percentage of 82%. No lead-related complications were observed. Conclusion CS pacing is a feasible and safe strategy for patients requiring PPM implantation after TVR, offering stable electrical performance and avoiding the risks of transvalvular and epicardial leads. This approach may be particularly valuable in patients with mechanical prostheses and should be considered in bioprosthetic valve recipients. Larger studies are needed to validate long-term outcomes.