Transvenous biventricular pacing in double-inlet left ventricle following ventricular septation and atrioventricular valve replacement

Here we report the first case of successful transvenous biventricular (BiV) pacemaker implantation in a 32-year-old man with double-inlet left ventricle following mechanical atrioventricular valve replacement and permanent atrial fibrillation. The patient underwent ventricular septation and epicardial pacemaker implantation for a surgical heart block at 4 years of age and mechanical right-side atrioventricular valve (functional tricuspid valve) replacement at 21 years of age. Because of epicardial pacing lead failure and worsening heart failure, we attempted to place BiV transvenous pacing leads. We cannulated the coronary sinus using a Selectra lead delivery catheter (Biotronik) and placed a quadripolar lead (Quartet model 1458Q; St. Jude Medical) into a branch of the lateral cardiac vein (Panel B). An additional bipolar lead (QuickFlex model 1258T; St. Jude Medical) was placed into an anomalous small anterior cardiac vein branching from the right atrium to establish BiV pacing (Panels A andB). A BiV pacemaker (Allure Quadra RF CRT-P PM3242, St. Jude Medical) was implanted in the left chest and programmed in the BiV-VVIR mode, resulting in stable BiV pacing, narrowing of the QRS duration from 194 to 158  ms, and improvement in the heart failure symptoms.
Source: Europace - Category: Cardiology Source Type: research