Cardiac implantable electronic devices in the setting of tricuspid valve intervention: Risks, options, extraction and future perspectives: A state-of-the-art review

Abstract

Tricuspid regurgitation is associated with increased risk of heart failure and mortality. To address this, tricuspid valve (TV) interventions in the form of transcatheter and surgical TV procedures have rapidly emerged. TV interventions are associated with a significant risk of conduction system disease necessitating permanent pacemaker (PPM) implantation. Limited data and current guidelines suggest that transvalvular PPM should be avoided to preserve the function of replaced or repaired TVs. With the rapid increase of transcatheter tricuspid valve-in-valve replacements in the last decade, the incidence of pre-existing PPM lead entrapment poses a clinical challenge in which lead extraction is indicated, particularly in the context of device infection. In this review article, we discuss the risks of conduction system disease associated with different TV interventions, the options for pacing, defibrillator therapy and cardiac resynchronization therapy that spare the TV, and the management of pre-existing transvalvular pacing leads before TV intervention. Furthermore, we discuss the future perspectives in this field, including a completely leadless cardiac resynchronization therapy-defibrillator system, and propose an algorithm for cardiac implantable electronic devices (CIED) implantation during or after TV intervention.