Coronary Sinus Pacing After Tricuspid Valve Intervention: Single-Center Case Series

Coronary sinus (CS) pacing represents a promising alternative for patients requiring ventricular pacing after tricuspid valve interventions, where traditional right ventricular lead placement may exacerbate regurgitation. In this single-center community hospital case series, we evaluated the safety and efficacy of CS pacing in 4 patients with prior tricuspid valve repair or replacement. All patients underwent successful CS lead implantation using fluoroscopic guidance, with leads positioned in lateral or anterior branches of the CS. Postprocedural assessments demonstrated stable pacing thresholds, consistent R-wave sensing, and improved clinical symptoms during short to intermediate-term follow-up. No major procedural complications, lead dislodgement, or adverse events were observed. These findings suggest that CS pacing is a safe and effective strategy to preserve prosthetic valve function and mitigate complications of transtricuspid lead placement. Early evaluation of pacing needs during procedural planning may optimize patient outcomes and successfully broaden CS pacing indications in patients with structural heart disease.