# Transcatheter Tricuspid Valve Replacement in the Presence of Pacemaker Lead–Related Tricuspid Regurgitation and Complex Anatomy

## TL;DR

A 76-year-old woman with severe tricuspid regurgitation due to pacemaker leads underwent successful transcatheter valve replacement, showing it's a viable option for complex cases.

## Contribution

The paper presents a successful case of TTVR in a patient with complex anatomy and pacemaker-related TR, emphasizing heart team collaboration.

## Key findings

- TTVR improved echocardiographic results and quality of life in a patient with lead-related TR.
- Multimodality imaging is essential for assessing complex valve anatomy before TTVR.
- Heart team collaboration, including electrophysiology, is crucial for managing CIED-related TR.

## Abstract

Cardiac implantable electronic device (CIED)–related tricuspid regurgitation (TR) is increasingly recognized, necessitating heart team assessment. Transcatheter tricuspid valve replacement (TTVR) is emerging as an option for inoperable patients with TR, requiring decisions on right ventricular lead management.

A 76-year-old woman developed moderate to severe TR after pacemaker implantation, which was exacerbated by a second RV lead 8 years later, leading to torrential TR and recurrent heart failure hospitalizations. TR persisted despite lead extraction, and multimodality imaging revealed complex valve anatomy. TTVR was performed, yielding excellent echocardiographic results and improved quality of life.

CIED and TR can coexist, obscuring the distinction between lead-related and lead-associated TR because of right ventricular remodeling. The heart team should determine lead management during transcatheter procedures. TTVR is a valuable option for massive gaps, severe tethering, or complex anatomy.

Collaborative management with electrophysiology as part of the extended heart team is key in CIED-related TR cases.