Outcomes of Entrapped Right Ventricular Pacing or Defibrillator Leads Following Transcatheter Tricuspid Valve Replacement.

BACKGROUND

In patients with a cardiac implantable electronic device (CIED) using a transvenous right ventricular (RV) lead, transcatheter tricuspid valve replacement (TTVR) results in RV lead entrapment.

OBJECTIVES

The authors sought to evaluate outcomes of patients with pre-existing transvenous RV leads undergoing EVOQUE TTVR.

METHODS

Patients with a CIED referred for TTVR at 3 centers were evaluated preoperatively by the heart team. Lead and clinical assessments were performed at baseline and in follow-up per local clinical practice. The primary outcome was the nature and incidence of major lead-related complications after TTVR. Secondary outcomes included changes in lead parameters after entrapment.

RESULTS

Of 146 EVOQUE TTVR, 52 consecutive patients with entrapped RV leads (age 81 [77-85] years; 33 female patients (63.5%), lead dwell time 8.9 [3.3-13.6] years) were evaluated. Paravalvular leak was mild or less in 47 of 48 patients (98%) 30 days post-TTVR. Four patients had procedure-related lead complications: 1 intraprocedural RV lead dislodgement; 2 implantable cardioverter-defibrillator lead fractures 6- and 8-weeks post-TTVR; and 1 methicillin-resistant Staphylococcus aureus endocarditis 1 month post-TTVR. Among 46 complication-free patients with follow-up >30 days (356 [196-965] days), there were no other lead-related adverse events. Of the 33 patients without complications who had ≥1 CIED interrogation >30 days (424 [182-1,006] days) following TTVR, there was a significant decrease in lead impedance and increase in capture threshold on the final lead assessment, but no additional patients required lead revision.

CONCLUSIONS

Following TTVR, most with entrapped RV leads remain free of lead-related complications. The need for urgent CIED revision due to RV lead dislodgment or failure is uncommon but may occur.