Many patients require permanent pacing after surgical tricuspid valve (TV) repair or replacement, complicating future attempts at transcatheter TV replacement (TTVR). Unfortunately, the best approach to managing transvenous pacing leads in those requiring TV replacement is unknown.

The authors sought to examine the incidence and types of permanent pacemaker lead complications in a large multicenter registry cohort of patients undergoing TTVR within a previously placed TV bioprosthesis or annuloplasty ring.

Overall, 39% of patients undergoing TTVR (128/329) had pacing systems in place – 70 epicardial and 58 transvenous, with 31 having leads passing through the TV. One patient experienced lead failure during the procedure, and 2 had lead failure during follow-up. Still, there were no significant differences in the relevant outcomes between those with and without lead entrapment.  As TTVR gains wider acceptance, understanding the best approach to managing transvenous pacing systems is imperative. 

While this critical work leaves many questions unanswered, it serves to reassure practitioners that entrapment of transvenous pacing leads does not appear to result in increased morbidity or mortality at medium-term follow-up. 

All editors: Konstantin Averin, MD, MS