Introduction
Transvenous right ventricular (RV) endocardial lead placement is the
conventional practice in clinical pacing. In some situations, as in the
presence of prosthetic tricuspid valve (PTV), the inaccessibility to the
RV makes the permanent pacing through a coronary sinus (CS) lead
placement a good alternative. [1-2] There are also
described cases of dual-site ventricular pacing through the coronary
sinus to cardiac resynchronization in patients with high pacemaker
dependance and lower left ventricle (LV) ejection fraction.[3-5]
Epicardial lead implantation may be an alternative but requires invasive
surgical placement, making it a less ideal option in patients with a
prior thoracotomy. Regarding single ventricle pacing with a CS lead, low
sensing and unacceptable threshold at implantation can be an important
issue, especially when using a conventional RV pacing lead.[1-2] Quadripolar LV leads are associated with
more satisfactory results as they are able to pace in several places of
the LV wall, multiple vectors along the lead, allowing us to avoid
suboptimal pacing sites, such as places with fibrosis.[6]