Atrioventricular Block After EVOQUE Transcatheter Tricuspid Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter tricuspid valve replacement (TTVR) is an emerging treatment for severe tricuspid regurgitation.
• The Evoque TTVR system is a novel device used in this procedure.
• New atrioventricular (AV) block is a potential complication following TTVR.

Purpose of the Study:

• To evaluate the incidence and timing of new-onset atrioventricular (AV) block after Evoque TTVR.
• To assess the management and outcomes of new AV block post-Evoque TTVR.
• To analyze the effectiveness of a specific post-procedural monitoring strategy.

Main Methods:

• A real-world study involving 106 Evoque TTVR recipients.
• Analysis focused on 55 patients without prior pacemakers meeting inclusion criteria.
• Retrospective review of procedural data, complication rates, and patient monitoring records.

Main Results:

• A 25% incidence (14 of 55 patients) of new AV block occurred after Evoque TTVR.
• New AV block developed within a median of 26 hours post-procedure, with some cases as late as 7 days.
• 12 of 14 new AV block cases were successfully treated with leadless pacemaker implantation (Micra).
• An institutional monitoring strategy (48-hour inpatient, then outpatient telemetry) identified 12 of 14 cases before symptom onset.

Conclusions:

• New AV block is a significant complication of Evoque TTVR, occurring in 25% of eligible patients.
• Leadless pacemaker implantation is an effective treatment for post-TTVR AV block.
• Early and continuous patient monitoring is crucial for timely detection and management of post-TTVR AV block.