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Updated: Aug 6, 2026
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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Valve-Sparing Pacing Strategies After Tricuspid TEER: An Imaging-Guided Case Series
Patricia Azañón-Cantero1, Pablo J Sánchez-Millán1, Lucía Torres Quintero1
1Department of Cardiology, University Hospital Virgen De Las Nieves, Granada, Spain.
Pacing and Clinical Electrophysiology : PACE
|July 22, 2026
Summary
Permanent pacing after tricuspid repair is challenging. Valve-sparing strategies using leadless pacemakers or conduction system pacing, guided by imaging, are safe and effective options.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Permanent pacing post-tricuspid transcatheter edge-to-edge repair (TEER) presents challenges due to potential device interactions.
- Limited evidence exists for optimal pacing strategies in patients with prior tricuspid TEER.
Purpose of the Study:
- To evaluate the feasibility and safety of valve-sparing pacing strategies in patients who have undergone tricuspid TEER.
- To explore the role of multimodality imaging in guiding device selection and procedural planning.
Main Methods:
- A single-center case series of three patients with prior tricuspid TEER requiring permanent pacing.
- Multimodality imaging (transesophageal echocardiography, intracardiac echocardiography) guided device selection and planning.
- Valve-sparing pacing strategies were tailored to individual patient profiles.
Main Results:
- Two patients received leadless pacemakers; one underwent left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy.
- Imaging guidance facilitated safe device implantation, avoiding interaction with TEER devices.
- All procedures were successful with stable pacing and no complications; tricuspid regurgitation remained unchanged.
Conclusions:
- Multimodality imaging-guided, valve-sparing pacing strategies are feasible and safe in patients post-tricuspid TEER.
- Leadless pacemakers and conduction system pacing (including LBBAP) offer tailored, complementary solutions.
- Successful LBBAP improved left ventricular function in a patient with dilated cardiomyopathy.
