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

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.

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.

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.

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.

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.