LV pacing as an alternative option to conventional RV pacing in a patient with tricuspid valve replacement

Tricuspid regurgitation (TR) is a relatively common anomaly. In patients with tricuspid valve repair/replacement (TVR)the control of atrioventricular conduction irregularity can be demanding, given the unavailability for implantation of the right ventricular (RV) endocardial lead, which is not recommended in such cases because of the risk of lead fracture at the valve site and valve damage or failure. Thus, epicardial lead may be an option; it requires a surgical procedure and it is not preferred in patients with prior thoracotomy. Lead implantation via coronary sinus (CS) can be an alternative to conventional right ventricular pacing in this patient population.