Leadless Pacing for Delayed Heart Block After Transcatheter Tricupid Valve Replacement.

BACKGROUND

Transcatheter tricuspid valve replacement (TTVR) is a minimally invasive treatment for severe tricuspid regurgitation. However, atrioventricular block (AVB) requiring permanent pacemaker implantation occurs in 12.0% to 13.3% of patients without a pacemaker.

CASE SUMMARY: An 81-year-old man presented 7 days after TTVR with dyspnea and dizziness. Electrocardiography showed alternating AVB, and monitoring indicated a transient episode of complete AVB, suggesting a premonitory sign of delayed conduction disease after EVOQUE implantation. A leadless pacemaker (Micra VR) was implanted to avoid interference with the prosthetic tricuspid valve. The procedure was uneventful, and follow-up showed stable pacemaker parameters and preserved prosthetic valve function.

DISCUSSION: This case review summarizes conduction disturbances after TTVR, pacing strategies, and postprocedural monitoring. In the absence of recommendations, pacemaker selection should be individualized, with leadless pacing representing a valve-sparing strategy.

TAKE-HOME MESSAGES: Delayed AVB may occur after TTVR, with an alternating AVB as a premonitory sign. Leadless pacemakers offer a valve-sparing pacing option.