Work

Transjugular leadless pacemaker implantation after transcatheter tricuspid valve replacement with a biological prosthetic valve: a case report

Year: 2025

Type: article

Abstract: Background: Transcatheter tricuspid valve replacement (TTVR) is an emerging therapy for patients with severe tricuspid regurgitation who are not candidates for surgery. Post-procedural atrioventricular (AV) block may necessitate permanent pacing, but traditional transvenous systems are often contraindicated in the setting of a tricuspid prosthetic valve. Leadless pacemakers represent a valuable alternative, though anatomic changes after valve implantation may challenge standard transfemoral delivery. Case summary: We report the case of an 82-year-old woman who underwent successful TTVR for severe tricuspid regurgitation. Three days later, she developed complete AV block requiring permanent pacing. Attempts to implant a leadless pacemaker via the right femoral vein failed due to altered tricuspid valve orientation. A transjugular approach enabled effective deployment of the device on the interventricular septum. Discussion: High-degree AV block is not an infrequent complication occurring after TTVR. Pacing strategies to spare further valve disturbances are mainly represented by single-lead pacing via the coronary sinus and leadless cardiac pacemaker implantation. An individualized approach based on anatomical considerations is essential in the context of complex structural heart interventions. Conclusion: The transjugular approach can serve as a reliable alternative for leadless pacemaker delivery in patients with tricuspid biological prosthetic valve, offering favourable curvature and access in anatomically challenging cases.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytaf609

Authors: Matteo Fortuna, Nicolas Dumonteil, Didier Tchetche, Matthieu Audoubert, Romain Cassagneau

Institution: Clinique Pasteur

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $815