Epicardial Lead Dysfunction in a Patient With Mechanical Tricuspid Valve-A Challenging Complication.
Complete atrioventricular block after mechanical tricuspid valve replacement represents a challenging pacing scenario because transvalvular right ventricular lead placement is contraindicated. We report a 51-year-old woman with mechanical mitral and tricuspid valves who presented with syncope and complete AV block due to late epicardial lead dysfunction. Transient restoration of capture during transthoracic echocardiography suggested dynamic lead-myocardial contact or intermittent lead continuity. Coronary sinus pacing was attempted but abandoned because of intolerable diaphragmatic stimulation. The patient later deteriorated and died from septic shock. This case highlights the limitations of available pacing strategies after mechanical tricuspid valve replacement.