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Transcatheter Tricuspid Valve Replacement for His Bundle Pacing Lead-Associated Tricuspid Regurgitation
Karishma Pareek1, Maximilian Reisinger2, Daniel Lustgarten1
1Division of Cardiology, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
Objective:
To describe the management of lead-associated tricuspid regurgitation (TR) using transcatheter tricuspid valve replacement (TTVR) in a patient with His bundle pacing (HBP).
Key Steps:
A multidisciplinary heart team recommended TTVR for suspected HBP lead-associated TR after failed lead extraction. The tricuspid valve was crossed posterior and lateral to the leads under transesophageal echocardiographic and fluoroscopic guidance to avoid entanglement. The TTVR delivery system was advanced across the tricuspid annulus and optimized for position and trajectory. After confirming leaflet capture, the valve was deployed stepwise. Postprocedural device interrogation was performed to assess for compromise to lead function.
Potential Pitfalls:
Avoiding entanglement with transvalvular leads is critical but can be technically challenging. Although pacemaker malfunction after lead jailing is uncommon, HBP leads may be particularly vulnerable given their fragility and the proximity of their distal tip to the tricuspid valve annulus.
Take-Home Message:
TTVR can be performed safely and effectively in patients with HBP lead-associated TR.
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