Cardiac implantable electronic device implantation and function after transcatheter tricuspid valve replacement - PubMed (original) (raw)

. 2025 Dec;22(12):e1269-e1274.

doi: 10.1016/j.hrthm.2025.07.049. Epub 2025 Aug 5.

Affiliations

Cardiac implantable electronic device implantation and function after transcatheter tricuspid valve replacement

Eric D Braunstein et al. Heart Rhythm. 2025 Dec.

Abstract

Background: Transcatheter tricuspid valve replacement (TTVR) has been introduced as a minimally invasive treatment for tricuspid regurgitation. Cardiac implantable electronic devices (CIEDs) commonly coexist with tricuspid regurgitation, and TTVR may cause bradyarrhythmias necessitating pacing.

Objective: The purpose of this study was to describe CIED outcomes after TTVR, including the incidence of bradyarrhythmias and pacemaker implantation, as well as outcomes in patients with preexisting CIEDs.

Methods: Patients undergoing TTVR with and without CIED systems were studied. For patients with CIEDs, device and clinical outcomes were analyzed. For patients without CIEDs, risk factors for bradyarrhythmias and outcomes of pacemaker implantation were studied.

Results: Sixty-three patients underwent TTVR, of whom 42 (66.7%) did not have and 21 (33.3%) had existing CIEDs, including 17 (27.0%) with leads crossing the tricuspid valve. Of those without CIEDs, 13 (30.1%) had bradyarrhythmias requiring pacemaker implantation. Thirteen leadless pacemakers and 1 tricuspid valve sparing transvenous pacemaker were implanted successfully. Heart failure and longer QRS duration were risk factors for pacing. One patient with a right ventricular pacing lead had acute lead dislodgment requiring leadless pacemaker; the remaining devices had normal function postprocedurally and at short-term follow-up, and all TTVR procedures during which leads were "jailed" were performed successfully.

Conclusion: After TTVR, bradyarrhythmias necessitating pacemaker implantation were common, and CIED implantation, mainly consisting of leadless pacemaker implantation, was successful in all cases. In patients with preexisting CIEDs, all TTVR procedures were performed successfully, though lead-related complications did occur. Long-term follow-up of leads will be imperative to establish the safety of "jailed" CIED leads by TTVR devices.

Keywords: CIED; Heart block; ICD; Leadless pacemaker; Pacemaker; TTVR; Transcatheter tricuspid valve.

Copyright © 2025 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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Conflict of interest statement

Disclosures Dr Makkar has received grant support from Edwards Lifesciences. The other authors have no relevant financial disclosures or conflicts of interest.

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