Permanent pacemaker implantation in Ebstein anomaly with metallic tricuspid valve

Nagabhushan Doddaka, Revanth Vulli, Sourabh Agstam, Vikas Kadiyala


Right ventricular endocardial pacing is partially contraindicated in the presence of mechanical tricuspid valve. Occurrences of atrioventricular block are commonly associated in postoperative period in Ebstein anomaly repaired with mechanical tricuspid valve. Coronary sinus (CS) pacing is the preferred site in this scenario. However, the anatomical variations in Ebstein anomaly leads to difficulties in hooking the CS. With the help of real time left coronary injection enabled in understanding the anatomical orientation of CS ostium take off, leading to successful CS lead implantation.



Ebstein anomaly, Permanent pacemaker, CS, Metallic tricuspid valve

Full Text:



Anderson KR, Zuherhuhler JR, Anderson RH. Morphologic spectrum of Ebstein's anomaly of the heart-a review. Mayo Clinic Proc. 1979;54:174-80.

Bove EL, Kirsh MM, Valve replacement for Ebstein's anomaly of the tricuspid valve, J Thorac Cardiovasc Surg. 1979;78:114-9.

Jugdutt BI, Brooks CH, Sterns LP, Callaghan JC, Rossall RE. Surgical treatment of Ebstein's anomaly. J Thorac Cardiovasc Surg. 1977;73:114-9.

Ng R, Sommerville J, Ross D, Ebstein's anomaly: Late results of surgical correction. Eur J Cardiol.1979;9:39-52.

Fujiwara T, Kawada M, Harada M, Tanaka T, Tsuchida K, Umemura J et al. A successful case of tricuspid valve replacement HIS bundle interruption and atrio ventricular sequential pacemaker implantation for Ebstein's anomaly with Wolff-Parkinson-White syndrome. J Jpn Assoc Thorac Surg. 1984;32:82-7.

Pierard LA, Henrard L, Demoulin JC, Persistent atrial standstill in familial Ebstein's anomaly, Br Heart J. 1985;53:594-7.

Price JE, Amsterdam EA, Vera Z. Ebstein's disease associated with complete atrio ventricular block. Chest. 1978;73:542-4.

Allen MR, Hayes DL, Warnes CA, Danielson GK. Permanent pacing in Ebstein's anomaly. Pacing Clin Electrophysiol. 1997;20:1243-6.

Zipse MM, Groves DW, Khanna AD, Nguyen DT. An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve. Card Electrophysiol Clin. 2016;8:169-71.

Delarche N, Bader H, Lasserre R, Derval N, Debeugny S, Denard M et al. Importance of anterograde visualization of the coronary venous network by selective left coronary angiography prior to resynchronization. Pacing Clin Electrophysiol. 2007;30:70-6.