Alternatives of cardiac pacing in patients with tricuspid valve replacement and heart block

Rogelio Robledo Nolasco; José Carlos Buenfil Medina; Jaime Soto Solís; Neil Juárez Pelcastre; Gregorio Zaragoza Rodríguez; Jesús Flores Flores; José Luis Sánchez Pazarán; Mario Blanco Canto; Alejandro Cortés García; Vidal Efrén Reyes Barrera; Carlos Enrique Padilla Parga

2002, Number 3

Arch Cardiol Mex 2002; 72 (3)

Alternatives of cardiac pacing in patients with tricuspid valve replacement and heart block

Robledo NR, Buenfil MJC, Soto SJ, Juárez PN, Zaragoza RG, Flores FJ, Sánchez PJL, Blanco CM, Cortés GA, Reyes BVE, Padilla PCE

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Language: Spanish
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ABSTRACT

One of the complications of tricuspid valve replacement (TVR) is the complete heart block (CHB). In these patients an epicardial permanent pacemaker is frequently used but its insertion is another major operation and higher thresholds are needed. Two patients are reported, both women, with rheumatic heart disease and TVR who required a permanent pacemaker because they developed CHB. The first patient underwent mitral valve replacement with a disc valve seventeen years before and TVR recently. A single chamber pacemaker was implanted. Left ventricular pacing was achieved through the great cardiac vein. The acute and chronic pacing thresholds were adequate. The second patient underwent tricuspid and mitral replacement with a Starr-Edwards (SE) valve. Eighteen years later this patient had atrial fibrillation with slow ventricular response and heart failure. The pacemaker lead had to be inserted across the tricuspid SE valve because ventricle pacing through the coronary veins was unsuccessful. The endocardial pacing resulted in mild tricuspid regurgitation and has continued the same way for four years. To conclude, ventricle pacing through the coronary veins is safe, produces excellent results and fewer complications. On the other hand, ventricle pacing across a prosthetic tricuspid valve remains questionable because of possible damage to the prosthesis itself leading to valve insufficiency and because of damage to the pacing lead.

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