Epicardial Lead Dysfunction in a Patient With Mechanical Tricuspid Valve—A Challenging Complication

Figures

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  FIGURE 1. Surface ECG recorded at admission demonstrating complete atrioventricular block with a ventricular escape rate of 36 bpm. No atrial activity is visible. Regular pacemaker spikes are present but show no consistent relationship to the narrow QRS complexes, indicating complete failure of ventricular capture. The narrow QRS morphology of the escape rhythm suggests a junctional or high‐septal origin.

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  FIGURE 2. Surface ECG recorded immediately before application of transthoracic echocardiographic probe pressure. The first 6 s show regular pacemaker spikes with no consistent association with QRS complexes and a ventricular rate of 35 bpm, consistent with ongoing pacing failure. In the final 4 s of the recording, pacemaker spikes are followed by broad QRS complexes, suggesting intermittent ventricular capture.

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  FIGURE 3. Surface ECG recorded during application of firm transthoracic echocardiographic probe pressure over the cardiac apex. Each pacemaker spike is consistently followed by a broad QRS complex at a rate of 52 bpm, corresponding to the programmed pacing rate and indicating sustained ventricular capture. The contrast with Figure 2 illustrates the dynamic nature of the lead–myocardial interface impairment in this patient.

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  FIGURE 4. Selective coronary sinus angiography.

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  FIGURE 5. Coronary sinus lead implantation.