New transvenous implantable cardioverter defibrillator configuration for use after tricuspid valve surgery.

A 57-year-old patient with a tricuspid valve (TV) prosthesis underwent successful atrioventricular pacing and internal defibrillation via a totally transvenous approach without crossing the TV. Ventricular pacing and sensing were obtained with a bipolar lead in the lateral cardiac vein. Internal defibrillation was obtained with a coil lead in the middle cardiac vein and an 'active can' pulse generator in the left infraclavicular region.