A 67-year-old woman was admitted to a Cardiology Department with clinical signs of decompensated heart failure on the background of atrial fibrillation with absolute arrhythmia and a history of syncope. The patient had a history of two tricuspid valve replacements. Transthoracic echocardiography revealed significant tricuspid stenosis of a biological Ionescu–Shiley valve prosthesis.
During hospitalization, episodes of bradycardia and prolonged pauses were recorded, necessitating implantation of a permanent pacemaker. Due to limited anatomical options, a PM-mode-CRT-P system was implanted with a single electrode.
Subsequent follow-up demonstrated satisfactory overall condition, without exacerbation of heart failure, and with effective ventricular pacing.
This case highlights the challenges in managing patients with biological tricuspid valve prostheses, in whom degenerative restenosis is a common late complication requiring an individualized approach when selecting the optimal pacing strategy.
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