Single site pacing through the anterior interventricular vein in a patient with a mechanic tricuspid valve

Transvenous endocardial pacing through classical implantation of a pace/sensing lead in the right ventricle is strictly contraindicated in patients with a mechanical tricuspid valve. Usually permanent pacing is achieved by an epimyocardial surgical approach. We hereby describe the implantation of a single site left ventricle pacing lead in the anterior interventricular vein in a 60 year-old woman with symptomatic bradycardia, permanent atrial fibrillation, and mechanical tricuspid valve. The described use of left ventricle pacing through a coronary vein lead, in a patient with favorable venous anatomy, provided (through a minimal invasive approach) effective with a low and stable threshold.