Successful use of transvenous atrial and bifocal left ventricular pacing in Ebstein's anomaly after tricuspid prosthetic valve surgery

A 62-year-old woman with Ebstein's anomaly and tricuspid valve prosthesis underwent placement of permanent atrioventricular pacemaker to treat highly symptomatic sinus node dysfunction and atrioventricular block. Transvenous bipolar leads were placed in the anterior cardiac and lateral coronary veins and were set to optimal ventricular pacing parameters to preserve prosthetic valve function, back-up ventricular pacing, and maintain atrioventricular and interventricular synchrony. An atrial septal lead was placed to control atrial pacing. Interventricular and atrioventricular timing were optimized with the use of tissue Doppler imaging and the Doppler-derived stroke volume.