Single-site ventricular pacing via the coronary sinus in patients with tricuspid valve disease

Aims To evaluate coronary sinus single-site (CS SS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated. Methods and results We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CS SS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RV SS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CS CRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CS SS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CS SS leads, the lead revision/abandonment was similar with RV SS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CS CRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CS SS and RV SS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CS CRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CS SS compared to RV SS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049). Conclusion In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.