A novel approach to atrial endocardial pacing

We describe a patient who had tricuspid valve replacement and in whom dual-chamber pacing was accomplished by using a ventricular epicardial lead and by placing an atrial endocardial lead through the wall of the atrial appendage and positioning the tip against the endocardial surface of the atrial appendage. A ligature was placed around the atrial appendage where the lead passed through the wall of the right atrial appendage. This obviated the need for a second procedure to place the atrial lead in a transvenous fashion. After 5 years of follow-up the patient continues with normal DVI pacing.