Left Ventricular Pacing in a Patient with a Mechanical Tricuspid Prosthesis and High Surgical Risk

Transvenous endocardial pacemaker (PM) implantation is contraindicated in patients with a mechanical tricuspid prosthesis. These patients usually undergo epicardial lead implantation. This case shows the implant of left ventricular (LV) pacing lead through the coronary sinus (CS) in a patient with high surgical risk. A 77-year-old woman with slow atrial fibrillation, left anterior hemiblock and right bundle brunch block, who previously underwent surgical replacement of the mitral and tricuspid valves, was admitted for PM implantation. After 1 month, all the electric parameters were stable. To the best of our knowledge, this is the first Italian case reported of LV pacing in a patient with a mechanical tricuspid prosthesis. The use of LV pacing leads implanted through the CS provides a minimal invasive, safe and effective strategy of pacing in patients with a mechanical tricuspid prosthesis.