Alternative pacing strategies after transcatheter tricuspid valve interventions: Procedural challenges and lessons...

Decision making regarding new pacemaker implantation after transcatheter tricuspid valve intervention (TTVI), including transcatheter edge-to-edge repair (TEER) or transcatheter tricuspid valve replacement (TTVR), is complex owing to anatomic and TTVI-related challenges.

This study aimed to evaluate the feasibility of nontransvalvular pacing strategies, including coronary sinus (CS) or leadless pacemaker (LP) placement, after TTVI.

Consecutive patients undergoing TTVI at a single institution were retrospectively studied for new pacemaker indications and pacing strategy. Procedural challenges and outcomes associated with nontransvalvular pacemaker implantation were assessed.

Among 137 patients who underwent TTVI (69 TTVR; 68 TEER) at a single center, 34 patients (25%) were excluded for preexisting pacemaker, and 15 of 103 patients (15%) subsequently developed an indication for pacing after TEER (n = 5 of 53; 9%) or TTVR (n = 10 of 50; 20%). An alternative pacing strategy was attempted after TEER and TTVR. After TEER (n = 5), CS lead placement was 50% successful (2 of 4) and 1 LP attempt was unsuccessful (0 of 1). After TTVR (n = 10), CS lead placement was 75% successful (6 of 8) and LP placement was 100% successful (2 of 2) on the initial attempt. CS lead placement was limited by CS anatomy, whereas LP placement was limited by TTVR interaction. A transvenous pacemaker was successfully placed if needed. No pacemaker device-related adverse event occurred in any patient peri-procedurally or at 1-year follow-up.

Alternative nontransvalvular pacing strategies may be feasible and safe in patients who require pacing after TTVI. Preprocedural planning with a multidisciplinary approach can help optimize procedural success. Further studies and longer-term follow-up are warranted.