[Leadless Pacemaker Implantation During Tricuspid Valve Surgery in the Presence of a Permanent Pacemaker with Tricuspid Regurgitation:Report of a Case].

A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation( AF). Echocardiography indicated progressive severe tricuspid regurgitation (TR) and right ventricular systolic dysfunction with tricuspid annular dilatation and tricuspid valve tethering. The pacemaker lead passing through the tricuspid valve may have contributed to TR, therefore we decided to perform tricuspid valve surgery, pacemaker lead removal, and leadless pacemaker implantation simultaneously during open heart surgery. Tricuspid annuloplasty was performed with the spiral suspension technique. The leadless pacemaker was anchored to the apical septum of the right ventricle through the tricuspid valve with endoscopic guidance, and left atrial appendage closure was performed for permanent AF. The patient was discharged on postoperative day 18 without major complications. He has been doing well with mild TR on transthoracic echocardiography as of three years post-operation.