Mekary Wissam, Ibrahim Rand, Lloyd Michael S, Bhatia Neal K, Westerman Stacy B, Shah Anand D, Byku Isida, Gleason Patrick, Greenbaum Adam, Babaliaros Vasilis, Merchant Faisal M, El-Chami Mikhael F
Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiology, Section of Structural Heart and Valve Disease, Emory University School of Medicine, Atlanta, Georgia.
Heart Rhythm. 2025 Feb 20. doi: 10.1016/j.hrthm.2025.02.004.
Patients requiring transcatheter tricuspid valve replacement (TTVR) often have a preexisting pacemaker lead crossing the tricuspid valve (TV). TTVR could also lead to heart block.
We aimed to describe pacing considerations in patients referred for TTVR.
We identified patients who underwent TTVR at Emory Healthcare. Clinical characteristics including presence of preexisting pacemaker leads, management of these TV leads at the time of TTVR, and pacing requirements after TTVR were collected.
Seventy-three patients underwent TTVR; 21 (29%) patients had preexisting permanent pacing systems (19 transvenous leads and 2 leadless pacemakers [LPs]). In 14 patients (73.7%), the transvenous lead was jailed. Five patients (26.3%) underwent lead extraction and implantation of a TV-sparing pacing system (n = 2) or ventricular LP (n = 2), whereas 1 patient did not undergo device reimplantation. After TTVR, 7 of 52 patients had heart block requiring permanent pacing (13%); 4 patients received an LP, 2 patients had a TV-sparing pacemaker implanted, and 1 had a lead implanted across the valve. During an average follow-up of 10.5 months, complications were reported in 3 of 14 patients with jailed leads (21%). Two patients required fractured lead revision. One of the revisions was complicated by infection, which resulted in the patient's death. A patient with a jailed right ventricular lead died suddenly 1 week after discharge.
More than 20% of patients with jailed leads after TTVR have serious complications due to lead malfunctions. TTVR-related heart block was common in our cohort (13%), and its treatment with LP or TV-sparing pacing systems was safe and effective.
需要经导管三尖瓣置换术（TTVR）的患者通常预先存在起搏器导线穿过三尖瓣（TV）的情况。TTVR也可能导致心脏传导阻滞。
我们旨在描述接受TTVR治疗的患者的起搏相关注意事项。
我们确定了在埃默里医疗中心接受TTVR治疗的患者。收集了临床特征，包括预先存在的起搏器导线情况、TTVR时这些TV导线的处理方式以及TTVR后的起搏需求。
73例患者接受了TTVR；21例（29%）患者预先存在永久性起搏系统（19根经静脉导线和2个无导线起搏器[LPs]）。14例患者（73.7%）的经静脉导线被固定。5例患者（26.3%）进行了导线拔除并植入了保留TV的起搏系统（n = 2）或心室LP（n = 2），而1例患者未进行装置再植入。TTVR后，52例患者中有7例出现心脏传导阻滞需要永久性起搏（13%）；4例患者接受了LP，2例患者植入了保留TV的起搏器，1例患者植入了穿过瓣膜的导线。在平均10.5个月的随访期间，14例固定导线患者中有3例（21%）报告了并发症。2例患者需要更换断裂导线。其中一次更换因感染而复杂化，导致患者死亡。1例右心室导线固定的患者在出院1周后突然死亡。
TTVR后导线固定的患者中，超过20%因导线故障出现严重并发症。TTVR相关的心脏传导阻滞在我们的队列中很常见（13%），使用LP或保留TV的起搏系统进行治疗是安全有效的。
