Transvenous left ventricular epicardial pacing in a patient with tricuspid mechanical prosthesis

Patients with tricuspid mechanical prosthetic valve cannot receive transvenous right ventricular lead implantation, and they generally have surgical epicardial lead implantation instead, which is a more invasive procedure. A 56-year-old man, who had undergone surgery for tricuspid mechanical prosthetic valve replacement seven years previously, had symptomatic sinus nodal dysfunction and required permanent pacemaker implantation. The patient underwent transvenous dual-chamber pacemaker implantation. A left ventricular epicardial electrode lead was successfully implanted through the coronary vein. We demonstrated the feasibility of applying the transvenous left ventricular epicardial approach for anti-bradycardia pacing, which can be used when the trans-tricuspid approach is not appropriate.