Clinical investigation of left ventricular pacing using coronary sinus in patients with mechanical prosthetic tricuspid valve replacement

BACKGROUND: Although transvenous right ventricular (RV) endocardial lead placement is routine practice in clinical pacing, RV inaccessibility in certain clinical situations mandates the search for other sites. HYPOTHESIS: This study is aimed to verify whether left ventricular lead through coronary sinus is safe and efficient. METHODS: Based on a retrospective analysis of a single-center series of 4 patients with inaccessibility for RV pacing, we report on the feasibility and reliability of coronary sinus (CS) pacing via left ventricular (LV) lead, which usually is used in cardiac resynchronization therapy. Four patients with valvular heart disease and bradycardias post-mechanical prosthetic tricuspid valve replacement were studied. The LV leads were implanted into the lateral vein or great cardiac vein of the CS, and all parameters were programmed postprocedure. RESULTS: In all cases procedures yielded favorable parameters, with 1 CS dissection. At long-term follow-up, there was no threshold increase or lead dislocation. CONCLUSIONS: LV lead implantation through the CS appears safe and efficacious in patients with inaccessibility for RV pacing.