Pacing considerations in patients undergoing transcatheter tricuspid valve replacement: Insights from a tertiary care center.

BACKGROUND

Patients requiring transcatheter tricuspid valve replacement (TTVR) often have a preexisting pacemaker lead crossing the tricuspid valve (TV). TTVR could also lead to heart block.

OBJECTIVE

We aimed to describe pacing considerations in patients referred for TTVR.

METHODS

We identified patients who underwent TTVR at Emory Healthcare. Clinical characteristics including presence of preexisting pacemaker leads, management of these TV leads at the time of TTVR, and pacing requirements after TTVR were collected.

RESULTS

Seventy-three patients underwent TTVR; 21 (29%) patients had preexisting permanent pacing systems (19 transvenous leads and 2 leadless pacemakers [LPs]). In 14 patients (73.7%), the transvenous lead was jailed. Five patients (26.3%) underwent lead extraction and implantation of a TV-sparing pacing system (n = 2) or ventricular LP (n = 2), whereas 1 patient did not undergo device reimplantation. After TTVR, 7 of 52 patients had heart block requiring permanent pacing (13%); 4 patients received an LP, 2 patients had a TV-sparing pacemaker implanted, and 1 had a lead implanted across the valve. During an average follow-up of 10.5 months, complications were reported in 3 of 14 patients with jailed leads (21%). Two patients required fractured lead revision. One of the revisions was complicated by infection, which resulted in the patient's death. A patient with a jailed right ventricular lead died suddenly 1 week after discharge.

CONCLUSION

More than 20% of patients with jailed leads after TTVR have serious complications due to lead malfunctions. TTVR-related heart block was common in our cohort (13%), and its treatment with LP or TV-sparing pacing systems was safe and effective.