Simultaneous Tricuspid Valve Replacement and Left Bundle Branch Area Pacing With Surgical Lead Refixation

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Surgery

Background:

• Tricuspid regurgitation (TR) management and tricuspid valve replacement (TVR) are increasingly common.
• Conduction system pacing (CSP), including left bundle branch area pacing (LBBAP), improves left ventricular (LV) synchrony but combining it with TVR is complex.

Purpose of the Study:

• To describe a novel approach for combining LBBAP with surgical TVR.
• To present a case of successful intraoperative lead management during combined LBBAP and TVR.

Main Methods:

• A patient with severe TR and LV dysfunction underwent LBBAP implantation followed by TVR.
• The LBBAP lead was dislodged intraoperatively and successfully reinserted and jailed outside the prosthetic valve.

Main Results:

• Postoperative improvement in pacing parameters and QRS duration was observed.
• Significant relief of heart failure symptoms and improved LV ejection fraction (LVEF) at three months.

Conclusions:

• Combining LBBAP and surgical TVR is feasible with careful intraoperative lead management.
• Jailing a lead with a prosthetic valve requires caution but can ensure long-term lead survival.