Leadless Pacemaker Implantation After Tricuspid Valve Replacement

Tricuspid valve disease is gaining clinical significance, with transcatheter tricuspid valve replacement (TTVR) emerging as a viable alternative to surgery. Atrioventricular block is a known postprocedural complication. To avoid interference with the valve prosthesis, leadless pacemakers (LPMs) are preferred over transvenous systems.

An 87-year-old woman developed symptomatic bradycardic atrial fibrillation 3 months after TTVR with an Evoque prosthesis (Edwards Lifesciences). Given her age and comorbidities, an AVEIR VR (Abbott Medical) LPM was implanted via right jugular vein approach, chosen because of the orientation of the prosthesis. During the first attempt, the pacemaker's helix became entangled in the valve frame despite the use of a protective sleeve. The device was safely retrieved, and a second attempt was successful. Postimplantation imaging confirmed preserved valve function.

This case underscores the importance of individualized procedural planning for LPM implantation after TTVR. The jugular approach, combined with tailored fluoroscopic angulation, can improve catheter control and reduce the risk of prosthesis interaction.

LPM implantation after TTVR is feasible. Optimal access selection, imaging strategy, and sheath handling are essential to minimize complications.