Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5562
Peer-review started: December 14, 2020
First decision: March 27, 2021
Revised: April 6, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: July 16, 2021
Processing time: 204 Days and 17.5 Hours
Temporary transvenous pacing through the coronary sinus is a novel approach rarely used in treating unstable bradycardia. This modality could provide cardiac pacing while achieving better ventricular synchrony. We present a case who received cardiac pacing through the coronary sinus and provide a summary of evidence in the current literature.
A 55-year-old woman with a history of advanced heart failure was admitted to the rehabilitation ward after a recent stroke. During hospitalization, she had paroxysmal atrial fibrillation with rapid ventricular response resulting from fluid overload. While atrial fibrillation was spontaneously reversed to sinus rhythm after diuresis, she developed multiple episodes of polymorphic ventricular tachycardia along with sinus bradycardia and prolonged QTc interval. She became hypotensive despite appropriate medical management. Pacing through her implantable cardioverter-defibrillator was attempted but worsened her hypotension. Ventricular dyssynchrony was suspected. Temporary transvenous atrial pacing through the coronary sinus was performed, which stabilized her blood pressure and improved end-organ perfusion. A permanent biventricular pacemaker was later implanted, and she was safely discharged to a nursing home.
Temporary transvenous pacing through the coronary sinus, a novel approach to treat unstable bradycardia, may reduce ventricular dyssynchrony.
Core Tip: We present a case who received cardiac pacing through the coronary sinus and provide a summary of evidence in the current literature. A 55-year-old woman with unstable bradycardia complicating cardiogenic shock achieved cardiac resynchronization with placement of a temporary pacing wire to the coronary sinus. This modality, compared to pacing through the right ventricle apex, may induce a more physiologic ventricular depolarization and decrease ventricular dyssynchrony. This approach was safely applied in patients who had risks of ventricular dyssynchrony or required temporary atrial pacing. Pitfalls such as technical requirements and potential complications should be considered prior to electrode lead placement.