His-Bundle Pacing From the Right Atrium in a Patient With Tetralogy of Fallot and a Prosthetic Tricuspid Valve.

Abstract

A mechanical tricuspid valve makes it difficult to implant a transvenous endocardial lead in the right ventricle , necessitating pacing by alternative nonphysiological methods such as implanting an epicardial lead and pacing through the coronary sinus . Permanent His-bundle pacing is an increasingly common method because it is the most physiological form of pacing and it can provide an effective alternative because the right atrial portion of the His bundle remains unaltered by the prosthetic tricuspid valve . Despite that, there are a small number of reported cases in patients with prosthetic tricuspid valve (1,2), and none of them were described in a patient with congenital heart disease .