Single-site ventricular pacing via the coronary sinus in patients with tricuspid valve disease.
To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated.



We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CSSS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CSSS leads, the lead revision/abandonment was similar with RVSS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CSCRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049).



In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.
Cardiovascular Division, Washington University, School of Medicine, 660 S. Euclid Ave, Campus Box 8086, St. Louis, MO, USA.
Amit
A
Noheria
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Martin
M
van Zyl
Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA.
Luis R
LR
Scott
Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA.
Komandoor
K
Srivathsan
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Malini
M
Madhavan
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Samuel J
SJ
Asirvatham
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Christopher J
CJ
McLeod
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D054326:Coronary Sinus / Q000503:physiopathology*; D005240:Feasibility Studies; D005260:Female; D006327:Heart Block / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology* / Q000601:surgery; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right