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Transjugular leadless pacemaker implantation after transcatheter tricuspid valve replacement with a biological
Matteo Fortuna1, Nicolas Dumonteil1, Didier Tchetche1
1Clinique Pasteur, Cardiology Department, Interventional Cardiology, 45 Avenue de Lombez, 31300 Toulouse, France.
Background:
Transcatheter tricuspid valve replacement (TTVR) is an emerging therapy for patients with severe tricuspid regurgitation who are not candidates for surgery. Post-procedural atrioventricular (AV) block may necessitate permanent pacing, but traditional transvenous systems are often contraindicated in the setting of a tricuspid prosthetic valve. Leadless pacemakers represent a valuable alternative, though anatomic changes after valve implantation may challenge standard transfemoral delivery.
Case Summary:
We report the case of an 82-year-old woman who underwent successful TTVR for severe tricuspid regurgitation. Three days later, she developed complete AV block requiring permanent pacing. Attempts to implant a leadless pacemaker via the right femoral vein failed due to altered tricuspid valve orientation. A transjugular approach enabled effective deployment of the device on the interventricular septum.
Discussion:
High-degree AV block is not an infrequent complication occurring after TTVR. Pacing strategies to spare further valve disturbances are mainly represented by single-lead pacing via the coronary sinus and leadless cardiac pacemaker implantation. An individualized approach based on anatomical considerations is essential in the context of complex structural heart interventions.
Conclusion:
The transjugular approach can serve as a reliable alternative for leadless pacemaker delivery in patients with tricuspid biological prosthetic valve, offering favourable curvature and access in anatomically challenging cases.
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