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Bazire B, Para M, Raffoul R, Nataf P, Cachier A, Extramiana F, Iung B, Algalarrondo V. Prophylactic epicardial pacemaker implantation in tricuspid valve replacement. Eur J Cardiothorac Surg 2023; 64:ezad344. [PMID: 37843446 DOI: 10.1093/ejcts/ezad344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/25/2023] [Accepted: 10/15/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES Patients undergoing surgical tricuspid valve replacement (TVR) are at high risk of atrioventricular conduction disorders. Because implanting a lead through the tricuspid bioprosthesis is discouraged, the patients who undergo TVR in our centre are usually given a prophylactic epicardial pacemaker. Our aim was to assess the benefits and risks of this strategy. METHODS Among the patients who underwent TVR with prophylactic epicardial pacemaker implantation, clinical evaluations and pacemaker reports were analysed retrospectively after surgery. The need for cardiac pacing were assessed by characterizing the atrioventricular conduction, while the risks were evaluated by listing and adjudicating post-operative events. RESULTS A total of 80 patients were analysed (mean age was 57 ± 16 years old, 30% males). TVR was isolated in 28 (35%) patients, but most often associated with another valve surgery. In the postoperative period, heart rhythm was analysed in 59/80 patients during a median follow-up of 35 months. Cardiac pacing was needed in 46% patients: 14% had complete pacing dependency, 17% had high degree AV block, while 15% had a high ventricular pacing rate (>80%). No pre- or per-operative variables could predict cardiac pacing requirement. Post-operatively, a spontaneous heart rate >70 bpm (P = 0.02) and the presence of narrow QRS (P = 0.03) were significantly associated with a lower risk of cardiac pacing requirement. Complications related to epicardial pacemaker were documented in 2 (2.5%) patients. CONCLUSIONS After TVR, cardiac pacing was needed in 46% of patients for post-operative atrioventricular conduction disorders. This high incidence associated with an acceptable safety profile supports a prophylactic epicardial pacing strategy for the patients undergoing TVR.
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Affiliation(s)
- Baptiste Bazire
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Marylou Para
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Richard Raffoul
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Patrick Nataf
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Agnès Cachier
- Service de Cardiologie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Fabrice Extramiana
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Vincent Algalarrondo
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
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Ríos-Ortega JC, Sisniegas-Razón J, Robles-Velarde V, Rodríguez-Urteaga Z. Is It Possible to Place a Pacemaker Lead Through a Bileaflet Mechanical Prosthesis? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:190-192. [PMID: 36872582 DOI: 10.1177/15569845231158656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.
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Affiliation(s)
- Josías C Ríos-Ortega
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
| | - Josué Sisniegas-Razón
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
| | - Víctor Robles-Velarde
- EsSalud, National Cardiovascular Institute, Cardiovascular Surgery Department, Lima, Peru
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Chen M, Wang Z, Wang S, Zhu T, Liu Z, Li X, Wu Z, Liu Q, Zhou S. Bedside temporary transvenous cardiac pacing lead placement in patients with tricuspid valve surgery without guidance of X‐ray: A single‐center experience. Ann Noninvasive Electrocardiol 2022; 27:e13006. [DOI: 10.1111/anec.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mingxian Chen
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Zhuo Wang
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Songyun Wang
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Tongjian Zhu
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Zhenjiang Liu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Xuping Li
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Zhihong Wu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Qiming Liu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Shenghua Zhou
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
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Examining the forgotten valve: outcomes of tricuspid valve surgery, a 15-year experience. Ir J Med Sci 2021; 191:699-704. [PMID: 33822313 DOI: 10.1007/s11845-021-02608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We have entered an era of renewed interest in novel approaches to surgical intervention and minimally invasive and transcatheter technique. With an aging population, isolated tricuspid valve regurgitation incidence is rising; however, referral for surgical intervention remains low. AIMS We undertook this retrospective review to assess outcomes and challenges associated with tricuspid valve intervention. METHODS A comprehensive retrospective review of all patients undergoing tricuspid valve intervention in our institution between 2004 and 2018 was carried out. RESULTS A total of 259 patients who underwent a tricuspid intervention between 2004 and 2018 were identified. Of those, 229 underwent a repair and 30 underwent a replacement. Median survival for repair was 3124 days, and replacement was 2294 days. In-patient mortality was 12% for those undergoing repair and 7% for the replacement patients. Of those undergoing redo tricuspid valve intervention, eight patients (61.5%) were alive at most recent follow-up. Eight patients required intraoperative pacemakers, 2 required postoperative pacemakers. Of those who had intraoperative epicardial pacing systems placed, 5 of the 8 remained pacing dependent on most recent follow up. CONCLUSION Beyond technical challenges, decision making regarding pacemaker requirement requires further exploration. Redo tricuspid valve surgery carries a significant mortality risk and consideration should be given to earlier intervention in this context.
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Guo J, Li L, Xiao G, Huang X, Li Q, Wang Y, Cai B. Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation. Clin Cardiol 2020; 43:1110-1118. [PMID: 32609400 PMCID: PMC7533988 DOI: 10.1002/clc.23413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. OBJECTIVE The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. METHODS LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. RESULTS LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ± 6.8 ms and 65.5 ± 5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51 ± 0.15 V@0.4 ms while the unipolar bundle capture threshold was 0.84 ± 0.51 V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ± 9.2 min and 81.7 ± 8.3 mGy, respectively. The average follow-up period was 10.4 ± 5.9 months (range 3-23 months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. CONCLUSIONS LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups.
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Affiliation(s)
- Jincun Guo
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Linlin Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Guosheng Xiao
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xinyi Huang
- Division of Echocardiography, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Qiang Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yan Wang
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Binni Cai
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
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Li TYW, Seow SC, Singh D, Yeo WT, Kojodjojo P, Lim TW. Left ventricular pacing in patients with preexisting tricuspid valve disease. J Arrhythm 2019; 35:836-841. [PMID: 31844475 PMCID: PMC6898538 DOI: 10.1002/joa3.12257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional right ventricular (RV) pacing is increasingly recognised to cause tricuspid valve (TV) injury or dysfunction, in part due to the need to pass the lead through the valve. This may be especially problematic in patients with preexisting TV disease or prior TV surgery. An alternative in this situation is to implant a left ventricular (LV) lead instead of ventricular pacing. METHODS We performed a single-center retrospective analysis of 26 patients with tricuspid valve surgery/disease who received a LV pacing lead in the coronary veins to avoid crossing the tricuspid valve, with or without a right atrial lead. A matched control population was obtained from patients receiving conventional right ventricular pacing and outcomes were compared. Main outcomes of interest were lead stability, electrical lead parameters and change in echocardiographic parameters such as left ventricular ejection fraction (LVEF) during long-term follow-up. RESULTS Successful left ventricular pacing was established in 25 out of the 26 cases with one case converted to a RV lead due to lead dislodgement. During the 2.96 ± 1.0 year follow-up, 24 of 25 (96.0%) leads were functional with stable pacing and sensing parameters, and 1 of 25 (4.0%) was extracted for due to device infection following an episode of thrombophlebitis. CONCLUSION We conclude that in patients with existing tricuspid valve disease or surgery, ventricular pacing via the coronary veins is a feasible, safe, and reliable alternative to right ventricular pacing.
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Affiliation(s)
- Tony Y. W. Li
- Department of MedicineNational University HospitalSingapore
| | - Swee Chong Seow
- National University Heart Centre, Singapore (NUHCS)National University HospitalSingapore
| | - Devinder Singh
- National University Heart Centre, Singapore (NUHCS)National University HospitalSingapore
| | - Wee Tiong Yeo
- National University Heart Centre, Singapore (NUHCS)National University HospitalSingapore
| | - Pipin Kojodjojo
- National University Heart Centre, Singapore (NUHCS)National University HospitalSingapore
| | - Toon Wei Lim
- National University Heart Centre, Singapore (NUHCS)National University HospitalSingapore
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Noheria A, van Zyl M, Scott LR, Srivathsan K, Madhavan M, Asirvatham SJ, McLeod CJ. Single-site ventricular pacing via the coronary sinus in patients with tricuspid valve disease. Europace 2019; 20:636-642. [PMID: 28339945 DOI: 10.1093/europace/euw422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated. Methods and results We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CSSS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CSSS leads, the lead revision/abandonment was similar with RVSS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CSCRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049). Conclusion In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.
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Affiliation(s)
- Amit Noheria
- Cardiovascular Division, Washington University, School of Medicine, 660 S. Euclid Ave, Campus Box 8086, St. Louis, MO, USA
| | - Martin van Zyl
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis R Scott
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Sideris S, Drakopoulou M, Oikonomopoulos G, Gatzoulis K, Stavropoulos G, Limperiadis D, Toutouzas K, Tousoulis D, Kallikazaros I. Left Ventricular Pacing through Coronary Sinus Is Feasible and Safe for Patients with Prior Tricuspid Valve Intervention. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:378-81. [PMID: 26769172 DOI: 10.1111/pace.12815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the presence of tricuspid valve intervention, right ventricular lead implantation is associated with the potential risk of tricuspid valve malfunction leading to a tricuspid regurgitation. Few cases have been reported with successful left ventricular pacing via the coronary sinus (CS) after tricuspid valve replacement or repair. In this retrospective study, we present the long-term clinical outcomes of 17 patients who underwent CS lead implantation and left ventricular pacing. METHODS Seventeen consecutive patients referred to our institution with an indication of postprocedural pacemaker (PM) implantation after tricuspid valve intervention were retrospectively included in the study. The indication for device implantation in all patients was atrial fibrillation with a symptomatic pause ≥ 3.0 seconds. Thus, all devices implanted were ventricular rate responsive (VVIR). RESULTS All device implantations were successful and uncomplicated. Mean operation time was 60 ± 8 minutes. Mean fluoroscopy time was 8.3 ± 2.1 minutes. Mean R-wave sensing was 7.5 ± 2.0 mV with a mean slew rate of 2.2 V/s. A mean pacing threshold of 1.9 ± 0.3 V/0.4 ms was accepted as patients were not PM-dependent. The pacing impedance was 743.5 ± 109.71 Ohm. At 2-year follow-up, pacing sensing, threshold, and impedance values were unchanged and no lead dislodgement has been noted. CONCLUSIONS In patients with tricuspid valve intervention, left ventricular pacing might be the treatment of choice for permanent ventricular pacing, with all the advantages of the endovenous route as a minimally invasive approach.
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Affiliation(s)
- Skevos Sideris
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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Jo KH, Kim I, Ann SH, Oh YS. Implantation of a permanent pacemaker through the coronary sinus in a patient who underwent mechanical valve replacement for infective endocarditis with a complete atrioventricular block. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kwan Hoon Jo
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soe Hee Ann
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Seog Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA. Right-sided infective endocarditis: surgical management. Eur J Cardiothorac Surg 2012; 42:470-9. [PMID: 22427390 DOI: 10.1093/ejcts/ezs084] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Right-sided infective endocarditis (RSIE) accounts for 5-10% of all cases of infective endocarditis and is predominantly encountered among injecting drug users (IDUs). RSIE diagnosis requires a high index of suspicion as respiratory symptoms predominate. Prognosis of isolated RSIE is favourable, and most cases (70-80%) resolve following antibiotic administration. Surgical intervention is indicated in patients with persistent infection that does not respond to antibiotic therapy, recurrent pulmonary emboli, intractable heart failure and if the size of a vegetation increases or persists at >1 cm. Techniques can be divided into 'prosthetic' (valve replacement or prosthetic annular implantation) or 'non-prosthetic' ones (Kay's or De Vega's annuloplasty, bicuspidalization or valvectomy). In IDUs who run a high risk of complications, vegetectomy and valve repair, avoiding artificial material should be considered as the first line of surgical management as is associated with better late survival.
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Affiliation(s)
- Karolina Akinosoglou
- Section of Immunology and Infection, Faculty of Natural Sciences, Imperial College London, South Kensington, UK.
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Eleid MF, Blauwet LA, Cha YM, Connolly HM, Brady PA, Dearani JA, Espinosa RE. Bioprosthetic Tricuspid Valve Regurgitation Associated With Pacemaker or Defibrillator Lead Implantation. J Am Coll Cardiol 2012; 59:813-8. [DOI: 10.1016/j.jacc.2011.10.893] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/03/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022]
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12
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Lim PB, Lefroy DC. Right ventricular lead implantation facilitated by a guiding sheath in a patient with severe chamber dilatation with tricuspid regurgitation. Indian Pacing Electrophysiol J 2011; 11:156-8. [PMID: 21994475 PMCID: PMC3184453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Implantation of pacemakers can be challenging in the context of dilated cardiac chambers and valvular regurgitation. We report a difficult case of single chamber pacemaker implantation in a patient with restrictrive cardiomyopathy resulting in grossly enlarged atria and severe tricuspid regurgitation. In this situation, use of a slittable guiding sheath, more typically used for coronary sinus lead implantation, greatly facilitated rapid and stable deployment of the right ventricular lead.
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Biffi M, Bertini M, Ziacchi M, Boriani G. Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis. J Cardiovasc Electrophysiol 2007; 18:329-31. [PMID: 17319002 DOI: 10.1111/j.1540-8167.2006.00686.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. RESULTS We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. CONCLUSION Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis.
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Affiliation(s)
- Mauro Biffi
- Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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14
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Bos HS, Pop GAM, Stel EA, van Gelder BM. Dual Site Coronary Sinus Pacing in a Patient with an Artificial Tricuspid Valve Prosthesis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1451-2. [PMID: 15511260 DOI: 10.1111/j.1540-8159.2004.00655.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For safety reasons, two leads for left ventricular pacing were implanted in the coronary sinus of a pacemaker dependent patient with an artificial tricuspid valve prosthesis.
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Affiliation(s)
- Hans S Bos
- Department of Cardiology, St Radboud University Medical Center Nijmegen, The Netherlands
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15
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Hall R, Earley M. Learning on the Web. Case 1: syncope and palpitation in a patient following aortic valve replacement. Heart 2003; 89:979. [PMID: 17167942 PMCID: PMC1767803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
A usually very fit man aged 90 presented with syncope and angina of effort. He was found to have severe calcific aortic stenosis and associated coronary disease restricted to the left anterior descending (LAD) coronary artery. He underwent an aortic valve replacement with tissue prosthesis and a single coronary graft to the LAD. He came off bypass without difficulty but on the third postoperative period, when he had left the intensive care unit and was making excellent progress mobilising, he had further episodes of syncope and also developed palpitations. The significance of these symptoms and the diagnosis and treatment of these postoperative problems is discussed in an interactive case presentation.
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16
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Scheffer M, van Gelder B. Transvenous implantation of a ventricular pacing lead in a patient with an artificial tricuspid valve prosthesis. Neth Heart J 2003; 11:359-361. [PMID: 25696245 PMCID: PMC2499952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The preference for treatment of symptomatic bradycardia is transvenous right ventricular pacing combined with atrial synchronisation if applicable. In the case of congenital anomalies where no conduit is present between the peripheral veins and the right ventricle, it is not possible to place the ventricular pacing lead in the right ventricle. Also the presence of an artificial valve in the tricuspid position excludes placement of an endocardial right ventricular pacing lead. Since the introduction of biventricular pacing, new guiding catheters and leads used as a transvenous route for left ventricular pacing are available. We report implantation of a ventricular pacing lead in the great cardiac vein for permanent ventricular pacing in a patient with a tricuspid valve prosthesis.
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McGavigan AD, Morley-Davis A, Hogg KJ, Dunn FG. Coronary sinus pacing in an elderly patient with Bjork-Shiley tricuspid valve replacement. Scott Med J 2001; 46:148-9. [PMID: 11771496 DOI: 10.1177/003693300104600508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- A D McGavigan
- Department of Cardiology, Stobhill Hospital, Balornock Rd, Glasgow, G21 3UW.
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