An implantable cardioverter defibrillator in a patient with triple mechanical valves.

A patient with permanent atrial fibrillation, triple mechanical prosthetic valve replacements, and nonischemic cardiomyopathy presented with symptomatic high-grade atrioventricular block. A transvenous implantable cardioverter-defibrillator system was achieved with the defibrillator lead and bipolar pace-sense lead in separate anterolateral branches of the coronary sinus with successful defibrillation testing.