Active fixation pacing leads in the distal coronary venous system in patients with prosthetic tricuspid valve
Introduction Permanent pacemaker implantations in patients requiring ventricular pacing is usually accomplished by the placement of endocardial pacing lead in the right ventricle. In the presence of prothestic tricuspid valve, this method has the potential of causing complications to the lead or the prosthetic valve and thus not recommended. Pacing options for this group of patients include epicardial lead implantation or the placement of lead in the coronary sinus. We describe the use of active fixation lead mechanism in the coronary sinus to improve stability in this group of patients. Methods Between July 2010 until September 2011, we implanted 4F active fixation leads (SelectSecure Model 3830, Medtronic, Minneapolis, MN, USA) in three patients with prosthetic tricuspid valve who required ventricular pacing. Active fixation leads were used in view of lead instability with conventional coronary sinus pacing leads. The lead was positioned and actively fixed at its optimal at the distal coronary sinus. The performances of the leads and its related complications were then monitored. Results The leads were successfully implanted in all three patients. The peri implantation pacing parameters were within acceptable limits with pacing thresholds of 2.3, 1.2 and 0.5 V, respectively and pacing impedances of 1450, 817 and 1384 Ω. Follow up interrogation revealed stable pacing parameters. No immediate complications were observed. Conclusion A 4F active fixation lead placement at the distal coronary sinus to deliver left ventricular stimulation in patients with prosthetic tricuspid valve showed stable and consistent delivery of acceptable pacing performances.