A novel approach to transvenous dual-chamber pacing lead placement and cardiac defibrillator implantation after tricuspid valve replacement.

Pacing and Defibrillation Therapy. We report the successful use of a percutaneous, totally transvenous endocardial approach to atrioventricular pacing and internal cardiac defibrillation in an adult patient with tetralogy of Fallot who had undergone three previous cardiac operations, including a tricuspid valve replacement. Ventricular pacing and sensing were achieved with a bipolar lead in the lateral cardiac vein, and atrial pacing was attained in the region of Bachmann's bundle. Internal defibrillation was achieved with a coil lead in the middle cardiac vein and an "active can" pulse generator in the retromammary position. This minimally invasive method has significant potential benefits because it avoids epicardial placement via a thoracotomy and allows endocardial placement without crossing the tricuspid valve.