Transcatheter tricuspid edge-to-edge repair (T-TEER) reduced heart failure hospitalizations and improved quality of life compared to medical therapy alone in patients with tricuspid regurgitation and CIED leads, with a <1% risk of lead-related complications.
Provides a comprehensive framework for managing the 'two-device problem' of transvalvular CIED leads in patients undergoing transcatheter tricuspid valve interventions.
Tricuspid regurgitation (TR) in patients with transvalvular cardiac implantable electronic device (CIED) leads is increasingly encountered as transcatheter tricuspid valve interventions (TTVI) expand, yet integrated guidance for managing this “two-device problem” remains limited. We performed a focused synthesis of contemporary evidence, organizing findings around mechanisms and diagnosis of TR in the setting of CIED leads, lead–device interactions across TTVI platforms, and clinical trade-offs of transvenous lead extraction (TLE) versus lead preservation or jailing. CIED-associated TR can arise from lead–leaflet impingement, leaflet injury, fibrotic adhesion, pacing-induced remodeling, or infection; true CIED-induced TR accounts for a minority of clinically significant TR, yet progression of TR after lead implantation occurs in 7–45% of patients, and moderate-to-severe TR in CIED populations is associated with 1.6- to 2.5-fold increased mortality risk. Lead conflict and lifetime consequences differ by TTVI modality: repair approaches are generally more lead-tolerant, whereas valve replacement creates obligate lead jailing with implications for lead performance, future extraction feasibility, and infection management. Management of TR with transvalvular CIED leads requires integrated Heart Team planning that anticipates downstream device needs. Standardized TR phenotyping, lead-aware TTVI selection, valve-sparing rhythm-device strategies, and structured post-procedural surveillance may improve outcomes; prospective studies are needed to define optimal extract-versus-jail pathways.
Kamareddine et al. (Fri,) conducted a review in Adults with tricuspid regurgitation and transvalvular cardiac implantable electronic device (CIED) leads considered for transcatheter tricuspid valve interventions. Transcatheter tricuspid edge-to-edge repair (T-TEER) vs. Medical therapy was evaluated on Reduction of heart failure hospitalizations and improvement in quality of life and patient-reported health status at 1 year. Transcatheter tricuspid edge-to-edge repair (T-TEER) reduced heart failure hospitalizations and improved quality of life compared to medical therapy alone in patients with tricuspid regurgitation and CIED leads, with a <1% risk of lead-related complications.