Left ventricular pacing through coronary sinus after tricuspid valve replacement: A case report and review of the literature

In patients with a mechanical tricuspid prosthetic valve, the transvenous position of a ventricular lead through the coronary sinus (CS) is a good alternative option to right ventricular or epicardial lead implantation. In cardiac resynchronization therapy, pacing the left ventricular lateral wall was considered the best site for the CS lead. However, for patients without a left bundle branch block, the best position of CS leads remains controversial. Here, we present a case of placing CS lead in the anterior interventricular vein. Measurements at implantation and 2 years’ follow-up reported low pacing thresholds with good sensing thresholds. The electrocardiograph showed narrow QRS complexes (120 ms) and follow-up echocardiography at 2 years presented left ventricular ejection fraction 58.9%.