Endocardial pacing through a prosthetic tricuspid valve

Transvenous right ventricular pacing in a patient with tricuspid mechanical prosthesis

We report a patient in whom permanent endocardial pacing was accomplished by passage of the electrode through a mechanical tricuspid valve. Echocardiography study showed a minimal tricuspid regurgitation.

Transvenous bifocal left ventricular pacing after mechanical prosthetic tricuspid valve replacement with use of echocardiography to optimize pacing parameters

A 56-year-old woman underwent placement of a permanent pacemaker to treat symptomatic bradycardia; she had a documented, severe atrioventricular (AV) conduction abnormality and was not taking any AV node-blocking drugs. She had a mechanical prosthetic valve in the tricuspid position, which had been implanted for severe valvular insufficiency caused by rheumatic heart disease. Pacing leads were successfully placed transvenously in the anterior cardiac and a posterolateral vein, which avoided the need for repeat thoracotomy. Echocardiographic and Doppler parameters were used to optimize interventricular as well as septal-to-lateral left ventricular (LV) time delay and reduce or avoid interventricular and LV mechanical dyssynchrony.

Successful Use of Transvenous Atrial and Bifocal Left Ventricular Pacing in Ebstein’s Anomaly After Tricuspid Prosthetic Valve Surgery

A 62-year-old woman with Ebstein's anomaly and a tricuspid valve prosthesis underwent placement of a permanent atrioventricular pacemaker to treat highly symptomatic sinus node dysfunction and atrioventricular block. Transvenous bipolar leads were placed in the anterior cardiac and lateral coronary veins and were set to optimal ventricular pacing parameters to preserve prosthetic valve function, back-up ventricular pacing, and maintain atrioventricular and interventricular synchrony. An atrial septal lead was placed to control atrial pacing. Interventricular and atrioventricular timing were optimized with the use of tissue Doppler imaging and the Doppler-derived stroke volume.

Endocardial Ventricular Pacing Through a Bioprosthetic Tricuspid Valve

A patient with bioprosthetic tricuspid valve was treated with ventricular endocardial pacing using a new delivery system consisting of a steerable catheter and a 4.1 F bipolar, fixed-screw, steroid eluting lead. The functioning of the lead and bioprosthetic tricuspid valve was excellent during the following year.

Coronary sinus pacing in an elderly patient with Bjork-Shiley tricuspid valve replacement

We report the first case of permanent pacing via the coronary sinus in a patient with a Bjork-Shiley tricuspid valve replacement. This may be the route of choice in this group of patients.

Right Ventricular Endocardial Pacing with Tricuspid Valve Replacement

A novel technique for simultaneous tricuspid valve replacement and endocardial pacing is described. The technique was applied in a 67-year-old man who had previously undergone coronary artery bypass grafting and subsequent pericardiotomy via a left thoracotomy. He developed congestive heart failure due to tricuspid valve regurgitation as well as impaired left ventricular function with bradycardia. Endocardial pacing was successfully performed in conjunction with tricuspid valve replacement using a bioprosthesis via a right anterolateral thoracotomy.

Permanent pacing in patients with tricuspid valve replacements

OBJECTIVE

To assess the incidence and complications of permanent pacing in patients who undergo tricuspid valve replacement.

DESIGN

A retrospective study of records of patients who had a tricuspid valve replacement between 1978 and 1993 at the Middlesex hospital.

RESULTS

45 patients with tricuspid valve replacements were followed up for a total of 104 patient years. Ten patients (22%) required permanent pacing, five with epicardial leads and five with endocardial. Endocardial leads had significantly lower initial implantation thresholds and were associated with fewer complications.

CONCLUSION

Patients undergoing tricuspid valve replacement frequently require permanent pacing. Endocardial or epicardial lead insertion should be considered at the time of tricuspid valve replacement.