An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve.

In the presence of a mechanical tricuspid valve, endocardial right ventricular pacing is contraindicated, and permanent pacing is usually achieved via a surgically implanted epicardial lead. In a patient with Ebstein anomaly, a mechanical tricuspid valve, and complete heart block, transvenous pacing was achieved by implantation of a pace-sense lead in a coronary sinus ventricular branch. Noninvasive cardiac imaging can provide information regarding anatomic variation in patients with congenital heart disease or when there are challenges to lead placement. With careful planning and execution, endovascular pacing in patients with a mechanical tricuspid valve is feasible and can safely be performed.