PO-05-029 VENTRICULAR PACING IS RELIABLE WITH A SINGLE LEFT VENTRICULAR QUADRIPOLAR LEAD AND A PLUGGED RIGHT VENTRICULAR PORT IN PATIENTS WITH TRICUSPID VALVE REPAIR OR REPLACEMENT

Abstract

Transvenous ventricular pacing with a lead crossing a repaired or bioprosthetic tricuspid valve (TV) is undesirable due to the potential effect of permanent pacing leads on repaired or replaced TV function. One potential alternative is left ventricular (LV) pacing via the coronary sinus; however, LV pacing leads are associated with higher thresholds, potential for phrenic nerve stimulation, and lead instability requiring revision. While quadripolar LV leads offer improved lead stability and programmability from multiple electrode pair options, only Abbott CRT-P generators allow for sensing from an IS-4 lead without requiring an IS-1 lead plugged into the right ventricular (RV) port. Feasibility and outcomes with this pacing technique have not been previously reported. To study the reliability of LV-only pacing with a quadripolar lead and plugged RV port in patients with tricuspid valve repair or replacement. 10 consecutive patients with prior TV bioprosthesis or repair underwent quadripolar LV lead placement in CS branch veins with plugged RV port and were retrospectively analyzed. Patient demographics, procedure data, interrogation data and need for reprogramming or lead revision were collected over 16 months mean follow-up. Successful implantation an Abbott CRT-P device with LV quadripolar lead with a plugged RV port was achieved in all patients. 5/10 of these cases involved the concomitant extraction of an RV lead. The target branch vein selected was that which would provide the best perceived lead stability, which was the AIV in two patients and MCV in one patient. Implant LV lead thresholds ranged from 0.75V @ 0.4ms to 2.25V @ 0.4ms with little change in follow-up thresholds, which ranged from 0.5V @ 0.4s to 2.25V @ 0.4ms. No patient experienced undersensing or oversensing in follow-up and R waves were greater than 5 mV in all patients. No patients required lead revision and no patients developed a pacing induced cardiomyopathy (drop in LVEF ≤ 10%) with LV only pacing. Durable ventricular pacing utilizing a single quadripolar LV lead and CRT-P generator is feasible when a transvenous RV lead is undesirable. This can be achieved by utilizing a single manufacturer’s CRT-P generator with unique capability of ventricular sensing from the IS-4 port despite plugged RV IS-1 port. This technique is an attractive alternative to standard dual chamber pacing in patients with prior TV repair or bioprosthesis to reduce risk of future valve dysfunction.Tabled 1PatientAgeSexPacing IndicationRelative Contraindication for RV LeadLV Lead Implant VeinLV Sensing at ImplantLV Sensing at Follow-upLV Threshold at ImplantLV Threshold at Follow-upVP %Preimplant LVEFLast Follow-up LVEF169FSND / Paroxysmal AVBTricuspid Repair, annuloplastyMCV10.8mV>12mV[email protected][email protected]<1%60-65%60-65%233MParoxysmal AVBBioprosthetic Tricuspid ValvePosterolateral branch5.1mV7.2mV[email protected][email protected]2%50%64%342MComplete heart blockBioprosthetic Tricuspid ValvePosterior branch>12mV12mV[email protected][email protected]97%>55%>55%465FSinus node dysfunctionTricuspid Repair, annuloplastyAIV>12mV12mV[email protected][email protected]<1%35-40%35-40%526FComplete heart blockTricuspid Repair, annuloplastyAnterolateral branchNone at VVI 30None at VVI 30[email protected][email protected]92%50%51%669FComplete heart blockSevere TR, Anticipated Tricuspid ClipAIV11.4mV>12mV[email protected][email protected]98%>55%>55%765FSinus node dysfunctionTricuspid Repair, annuloplastyPosterolateral branch8.3mV7mV[email protected][email protected]4%55-60%58%831MComplete heart blockBioprosthetic Tricuspid ValvePosterior branchNone at VVI 30None at VVI 30[email protected][email protected]91%>55%58%957FComplete heart blockBioprosthetic Tricuspid ValveAnterolateral branch12mVNone at VVI 30[email protected][email protected]99%59%56%1057MComplete heart blockBioprosthetic Tricuspid ValvePosterolateral branchNone at VVI 30None at VVI 30[email protected][email protected]98%55-60%55-60% Open table in a new tab