Synchronizing the Beat: The Art and Science of Intracardiac Device Implantation

This is the case report of a 90-year-old woman with multiple prior valvular interventions and severe tricuspid regurgitation who underwent successful percutaneous tricuspid valve replacement with an EVOQUE bioprosthesis (Edwards Lifesciences). Despite initial success, she developed a right bundle branch block and high-degree atrioventricular block resulting in a traumatic syncopal episode, necessitating leadless pacemaker insertion. This case highlights the advancements in valvular interventions and intracardiac devices and the impact they have had in transforming the field of structural heart disease. We discuss the new challenges for interventionalists and electrophysiologists in device selection and the potential benefits of leadless pacemakers in patients with complex cardiac histories.