Left ventricular stimulation in a patient with tricuspid bioprosthesis

Abstract

A 66-year-old woman with a history of severe mitral stenosis, open heart valvotomy in 1958 and permanent atrial fibrillation was referred for cardiac pacemaker replacement. Mitral valve replacement with a mechanical prosthesis was performed in 1977, associated with tricuspid annuloplasty and insertion of a tricuspid ring. In 1999, tricuspid valve replacement was performed with a bioprosthetic valve. Permanent atrioventricular block occurred after cardiac surgery, leading to the implantation of a single-chamber pacemaker in the abdominal position associated with epicardial leads due to the risk of crossing the tricuspid prosthesis. During follow-up, the patient was poorly symptomatic with medical therapy. However, pacing threshold and sensing values increased over the years (2.5V at 1 ms) leading to replacement of the device in 2003. In accordance with the patient's wishes, the epigastric location was conserved, with elevated threshold after replacement, and the patient was informed of the high risk of premature failure. Three years later, interrogation of the pacemaker revealed high internal impedance, leading us to consider a novel device replacement.