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Prophylactic epicardial pacemaker implantation in tricuspid valve replacement
Baptiste Bazire1,2, Marylou Para2,3, Richard Raffoul3
1Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France.
Summary
Surgical tricuspid valve replacement (TVR) patients often need cardiac pacing due to conduction issues. Prophylactic epicardial pacemakers are safe and effective for these high-risk patients undergoing TVR.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Patients undergoing tricuspid valve replacement (TVR) face a high risk of atrioventricular conduction disorders.
- Implanting leads through tricuspid bioprostheses is generally discouraged, necessitating alternative pacing strategies.
Purpose of the Study:
- To evaluate the benefits and risks of prophylactic epicardial pacemaker implantation in patients undergoing tricuspid valve replacement (TVR).
Main Methods:
- Retrospective analysis of clinical evaluations and pacemaker reports in patients who underwent TVR with prophylactic epicardial pacemaker implantation.
- Assessment of the need for cardiac pacing by characterizing atrioventricular conduction.
- Evaluation of risks by documenting and adjudicating post-operative events.
Main Results:
- 46% of 80 analyzed patients required cardiac pacing post-TVR, with 14% experiencing complete pacing dependency and 17% high-degree atrioventricular block.
- No pre- or peri-operative variables predicted the need for pacing.
- Complications related to epicardial pacemakers were low (2.5%), with spontaneous heart rate >70 bpm and narrow QRS associated with lower pacing needs.
Conclusions:
- The high incidence of post-TVR atrioventricular conduction disorders supports the use of prophylactic epicardial pacing.
- This strategy demonstrates an acceptable safety profile, making it a viable option for patients undergoing tricuspid valve replacement.
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