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

1 adult patient with tetralogy of Fallot who had undergone three previous cardiac operations, including a tricuspid valve replacement.

Percutaneous, totally transvenous endocardial approach to atrioventricular pacing and internal cardiac defibrillation (ventricular pacing and sensing with a bipolar lead in the lateral cardiac vein, atrial pacing in the region of Bachmann's bundle, internal defibrillation with a coil lead in the middle cardiac vein and an active can pulse generator in the retromammary position).

Successful ventricular pacing and sensing, atrial pacing, and internal defibrillation.