Dual Coronary Sinus Lead Strategy to Avoid Tricuspid Valve Traversal in Biventricular Pacing

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Permanent pacing after tricuspid valve intervention is challenging due to the need to cross prosthetic valves.
• Existing pacing strategies may be complicated by tricuspid valve repair or replacement procedures.

Purpose of the Study:

• To evaluate the feasibility and performance of dual coronary sinus (CS) lead implantation for biventricular pacing in patients with prior tricuspid valve interventions.
• To assess the safety and efficacy of an approach that avoids transvalvular lead placement.

Main Methods:

• Retrospective case series of three patients undergoing dual CS lead implantation for biventricular pacing after various tricuspid valve interventions.
• Individualized lead placement based on coronary sinus anatomy and pacing parameters.
• Assessment of procedural success, pacing performance, and complications.

Main Results:

• Successful dual CS lead implantation was achieved in all three patients, avoiding tricuspid valve traversal.
• Satisfactory pacing performance and QRS narrowing were observed, with variations based on lead position.
• No procedural complications were reported.

Conclusions:

• Dual CS lead implantation is a technically feasible and potentially effective alternative for biventricular pacing in patients with prior tricuspid valve interventions.
• Individualized lead placement and device programming are crucial for optimizing pacing outcomes.
• Further research with larger cohorts is necessary to establish long-term efficacy and optimal use.