Soonchunhyang Med Sci.  2014 Dec;20(2):88-90. 10.0000/sms.2014.20.2.88.

Left Ventricular Pacing after Mitral, Tricuspid Valve Replacement without Interruption of Anticoagulation

• Ku YH
• Park HW
• Ahn S
• Ha SY
• Lee R
• Lee KH
• Cho JG

• KMID: 2317729
• DOI: http://doi.org/10.0000/sms.2014.20.2.88

Abstract

Pacemaker implantation for patients with mechanical tricuspid valve is quite challengeable because lead insertion through prosthetic tricuspid valve may cause valve dysfunction or lead impingement. Also complications due to interrupt of anticoagulation should be considered. A 65 years old woman received AAI (atrium paced, atrium sensed, inhibited) pacemaker for sick sinus syndrome and mechanical mitral valve replacement for severe mitral steno-insufficiency at the same time 16 years before. She needed to undergo mechanical tricuspid valve replacement (TVR) because of severe tricuspid regurgitation despite of medical therapy. Complete atrioventricular block developed during the TVR operation and it was not recovered even after several days of temporary pacing. We decided left ventricular pacing through coronary sinus because ventricular lead could not pass mechanical tricuspid or mitral valve and also planned to continue oral anticoagulation therapy. We could find a place where high pacing output did not pace phrenic nerve with acceptable sensing, pacing threshold. The patient recovered well without any periprocedural complications. Left ventriclcular pacing lead implantation through coronary sinus without interruption of anticoagulation can be an alternative to epicardial pacing for patients with mechanical tricuspid valve.

Keyword

Pacemaker; Tricuspid valve replacement; Anticoagulation

MeSH Terms

Atrioventricular Block
Coronary Sinus
Female
Humans
Mitral Valve
Phrenic Nerve
Sick Sinus Syndrome
Tricuspid Valve Insufficiency
Tricuspid Valve*