Transvenous-subcutaneous implantation of a cardioverter-defibrillator after bioprosthetic replacement of a tricuspid valve

The implantation of transvenous devices in patients who underwent tricuspid valve replacement represents problems, especially if an epicardial position is not available. The implantation of a "pace-sense" lead via the coronary sinus is a safe and feasible procedure. For experienced surgeons in implantation of biventricular devices, the implantation of leads via the coronary sinus is a routine procedure. Bipolar leads are essential for the correct sensing and pacing of the implantable cardioverter-defibrillator (ICD). In patients who underwent tricuspid valve replacement who have the indication of an ICD implantation postoperatively, the combination of a shock electrode placed in the superior vena cava, a subcutaneous array positioned on the left posterior close to the spine and an active can, placed subpectorally in the left infraclavicular region, is an alternative solution.