Coronary Sinus Lead Entrapment During Transcatheter Tricuspid Valve Replacement: Implications for Pacing-Dependent...

Entrapment of transvenous pacing leads resulting in lead failure is a well-known complication of transcatheter tricuspid valve replacement (TTVR). Current guidelines advise preemptive alternative pacing strategies that do not cross the tricuspid valve in pacing-dependent patients.

A pacing-dependent patient with a cardiac resynchronization therapy with defibrillator device underwent TTVR. He subsequently developed simultaneous fractures of his right ventricular and left ventricular leads, necessitating an epicardial pacing system.

Transvenous left ventricular pacing leads coursing near the tricuspid valve annulus can also be at risk of entrapment during TTVR, resulting in sudden lead failure.

Coronary sinus lead entrapment is a potential complication of TTVR, especially for leads coursing near the tricuspid valve annulus and/or when a large-diameter valve is deployed. TTVR in pacing-dependent patients in whom a pre-existing coronary sinus lead is the sole or backup means of pacing require meticulous attention during valve placement and close follow-up.