Intercommissural lead placement into a right ventricular coronary sinus--utility of intracardiac echo guidance

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Device Technology

Background:

• Congenital heart disease and prosthetic valves pose challenges for cardiac pacing lead placement.
• Right ventricular pacing through bioprosthetic tricuspid valves risks traumatic injury and dysfunction.
• Coronary sinus lead placement is an alternative to mitigate valvular complications.

Observation:

• An unusual case presented with the coronary sinus ostium located ventricular to a tricuspid prosthesis.
• Intracardiac echocardiography was utilized for precise lead positioning.
• The lead was successfully placed between the commissures of the tricuspid prosthesis.

Findings:

• Coronary sinus lead placement was achieved despite challenging anatomy.
• The procedure resulted in only trivial tricuspid regurgitation acutely.
• Trivial regurgitation persisted at the 1-year follow-up, indicating a stable outcome.

Implications:

• This case demonstrates the feasibility of coronary sinus lead placement in complex congenital heart disease patients with prosthetic valves.
• Intracardiac echocardiography is a valuable tool for navigating difficult lead placements.
• Successful lead placement can prevent prosthetic valve dysfunction, improving patient management.