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Pacing and Defibrillation Consideration in the Era of Transcatheter Tricuspid Valve Replacement

  • New Therapies for Cardiovascular Disease (AA Bavry and MR Massoomi, Section Editors)
  • Published:
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Abstract

Purpose of Review

Tricuspid regurgitation is a commonly encountered valvular pathology in patients with trans-tricuspid pacing or implantable cardioverter-defibrillator leads. Transcatheter tricuspid valve interventions are increasingly performed in patients at high surgical risk. Implantation of these valves can lead to the “jailing” of a trans-tricuspid lead. This practice carries both short- and long-term risks of lead failure and subsequent infection without the ability to perform traditional transvenous lead extraction. Herein, this manuscript reviews available therapeutic options for lead management in patients undergoing transcatheter tricuspid valve interventions.

Recent Findings

The decision to jail a lead may be appropriate in certain high-risk cases, though extraction may be a better option in most cases given the variety of options for re-implant, including leadless pacemakers, valve-sparing systems, epicardial leads, leads placed directly through prosthetic valves, and the completely subcutaneous implantable-defibrillator.

Summary

A growing number of patients meet the requirement for CIED implantation in the United States. A significant proportion of these patients will have tricuspid valve dysfunction, either related to or independent of their transvenous lead. As with any percutaneous intervention that has shown efficacy, the role of TTVI is also likely to increase as this therapy advances beyond the investigational phase. As such, the role of the heart team in the management of these patients will be increasingly critical in the years to come, and in those patients that have pre-existing CIED leads, we advocate for the involvement of an electrophysiologist in the heart team.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology-Section of Electrophysiology, Emory University School of Medicine, Medical Office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30312, USA

    Devinder S. Dhindsa, Wissam Mekary & Mikhael F. El-Chami

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  3. Mikhael F. El-Chami
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All authors contributed to drafting, editing, and critically reviewing the manuscript.

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Correspondence to Mikhael F. El-Chami.

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MFE is a consultant for Medtronic and Boston Scientific, and he is also on the Medtronic Advisory Board. The other authors declare that they have no conflict of interest.

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Dhindsa, D.S., Mekary, W. & El-Chami, M.F. Pacing and Defibrillation Consideration in the Era of Transcatheter Tricuspid Valve Replacement. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02032-7

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