Permanent transvenous dual-chamber pacing using the coronary sinus in a patient with a mechanical prosthetic tricuspid valve.

Ventricular pacing in patients with mechanical prosthetic tricuspid valves usually requires an epicardial approach. Epicardial pacing requires at least a limited thoracotomy and long-term pacing thresholds are generally inferior to thresholds achieved with transvenous pacing. This case report describes the use of a coronary sinus lead designed for left ventricular pacing as the sole ventricular lead in a dual-chamber pacing system in a young male with persistent complete atrioventricular block following remote ventricular septostomy and mechanical tricuspid valve replacement. With the development of dedicated, transvenous, left ventricular leads with stable positions and reliably low thresholds, ventricular pacing via the coronary sinus is a viable option when right ventricular pacing is impossible.