Incidence, Predictors, and Management of Conduction Disturbances After Transcatheter Tricuspid Valve Replacement: The TRIPLACE Registry
- PMID: 40637674
- DOI: 10.1016/j.jcin.2025.05.029
Incidence, Predictors, and Management of Conduction Disturbances After Transcatheter Tricuspid Valve Replacement: The TRIPLACE Registry
Abstract
Background: Transcatheter tricuspid valve replacement (TTVR) can induce high-grade atrioventricular block (HAVB), necessitating permanent pacemaker implantation (PPI). Limited data are available regarding this complication and management post-TTVR.
Objectives: The aim of this study was to investigate the incidence, predictors, and management of conduction disturbances after TTVR.
Methods: All consecutive patients undergoing TTVR in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were analyzed. The primary endpoint was the occurrence of HAVB at 1 month post-TTVR.
Results: Of 263 TTVR patients, 75 (28.5%) were excluded because of pre-existing PPI and 3 (1.1%) because of surgical conversion. At 1 month, HAVB had occurred in 25 of the remaining 185 patients (13.5%), 88% within the first week post-TTVR (median 3.0 days; Q1-Q3: 2.0-5.0). New-onset right bundle branch block was observed in 20.6% of patients. Baseline left bundle branch block or left anterior or posterior fascicular block (adjusted OR: 3.63; 95% CI: 1.28-10.37; P = 0.016) was independently associated with HAVB, after adjusting for age and degree of device oversizing. PPI was performed using leadless technologies (45.5%), coronary sinus leads (27.3%), or transvalvular dual-chamber pacemakers (27.3%).
Conclusions: HAVB occurred in 13.5% of PPI-naive patients who underwent TTVR. The majority of cases of HAVB (88%) were observed in the first week after TTVR. Baseline left bundle branch block or left anterior or posterior fascicular block confers a high risk for HAVB after TTVR. (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement [TRIPLACE]; NCT06033274).
Keywords: atrioventricular block; conduction disturbances; pacemaker; transcatheter tricuspid valve replacement; tricuspid regurgitation.
Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Puri is a consultant, speaker, and proctor for Medtronic and Abbott; is a consultant for Centerline Biomedical, Philips, Products & Features, Shockwave Medical, VDyne, VahatiCor, Advanced Nanotherapies, NuevoSono, TherOx, GE Healthcare, Anteris, T45 Labs, Pi-Cardia, AngioWave, Bioventrix, Protembis, HRT, and Nyra Medical; and has equity interest in Centerline Biomedical, VahatiCor, and NuevoSono. Dr Coisne is a proctor for Abbott Vascular; and has received speaker fees from Abbott Vascular, Bristol Myers Squibb, Edwards Lifesciences, GE Healthcare, Merck Sharp & Dohme, and Pfizer. Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Ho has served as a consultant for Medtronic, Abbott, Edwards Lifesciences, Philips, GE, Biosense Webster, Tioga, Nyra, Meocor, NeoChord, Half Moon, and Valgen. Dr Hausleiter has received research support and speaker honoraria from Edwards Lifesciences. Dr Maisano has received grant and/or research institutional support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo, and Venus; has received consulting fees and personal and institutional honoraria from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus, Squadra, and Valgen; has received royalty income from and holds intellectual property rights with Edwards Lifesciences; and is a shareholder (including share options) in Magenta, Transseptal Solutions, and 4Tech. Dr Rudolph has received speaker honoraria from Edwards Lifesciences. Dr Sievert has received institutional study honoraria, travel expenses, and consulting fees from 4Tech Cardio, Abbott, Ablative Solutions, Adona Medical, Akura Medical, Ancora Heart, Append Medical, Axon, Bavaria Medizin Technologie, Bioventrix, Boston Scientific, Cardiac Dimensions, Cardiac Success, Cardimed, Cardionovum, CeloNova BioSciences, Contego, Coramaze, CroiValve, CSL Behring, CVRx, Dinova, Edwards Lifesciences, Endobar, Endologix, Endomatic, Esperion Therapeutics, Hangzhou Nuomao Medtech, Holistick Medical, Intershunt, Intervene, K2, Laminar, Lifetech, Magenta, Maquet Getinge Group, Medtronic, Metavention, Mitralix, Mokita, Neurotronic, NXT Biomedical, Occlutech, Recor, Renal Guard, Terumo, Trisol, Vascular Dynamics, Vectorious Medtech, Venus, Venock, Vivasure Medical, Vvital Biomed, and Whiteswell. Dr Rodes-Cabau has received institutional research grants and speaker fees from Edwards Lifesciences. Dr Fam is consultant to Edwards Lifesciences, Abbott, Medtronic, and Cardiovalve. Dr Latib has served on advisory boards for Supira, Medtronic, Abbott Vascular, Boston Scientific, Edwards Lifesciences, Shifamed, NeoChord, VDyne, Philips, Centerline Biomedical, VahatiCor, Advanced Nanotherapies, NuevoSono, Anteris, T45 Labs, Tioga, and Nyra Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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