Atrioventricular Conduction Disturbances in Patients Undergoing Transcatheter Tricuspid Valve Intervention: A...

Tricuspid regurgitation (TR) is a highly prevalent valve disease, and cardiac surgery has been used in patients with severe symptomatic TR undergoing surgery for other cardiac lesions or less frequently for isolated TR. More recently, transcatheter therapies, particularly transcatheter edge-to-edge repair and valve replacement, have emerged as therapeutic alternatives in those considered at high to extreme risk for surgery. Because of the anatomical proximity of the tricuspid valve (TV) and the atrioventricular conduction system, the risk for high-degree atrioventricular block and permanent pacemaker implantation remains important, as they are common adverse events after transcatheter valve replacement. Furthermore, a significant number of these patients have cardiac implantable electronic devices with leads that may either worsen TR or complicate the treatment procedure. The aim of this review is to provide an overview of different TV interventions, focusing on the risk for atrioventricular conduction disturbances in patients without previous cardiac implantable electronic devices as well as the risk for pacemaker lead-related adverse events following transcatheter TV interventions. Finally, the authors propose a management algorithm for patients with conduction disturbances following TV intervention and for those with permanent leads undergoing transcatheter interventions.