Abstract 18123: Single-Site Ventricular Pacing via the Coronary Sinus in Patients With Tricuspid Valve Disease
Objectives: To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF).
Background: The coronary venous system is an alternative site for permanent pacing when a traditional right ventricular lead implantation is not feasible or is contraindicated.
Methods: We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up.
Results: Successful CSSS 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 CSSS leads, the lead revision/abandonment was similar with RVSS leads (HR 0.87, 95% CI 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4±11.0 versus 1.5±12.8, p=0.76), but LVEF improved in CSCRT group (11.2±16.5%, p=0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6±24.6 minutes versus 12.3±18.6 minutes, p=0.049).
Conclusions: In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.
Author Disclosures: M. van Zyl: None. A. Noheria: None. L.R. Scott: None. K. Srivathsan: None. M. Madhavan: Consultant/Advisory Board; Modest; Convatec Inc.. S.J. Asirvatham: None. C.J. McLeod: None.
- © 2016 by American Heart Association, Inc.