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Multicenter Study
. 2025 Jul 28;18(14):1762-1772.
doi: 10.1016/j.jcin.2025.05.042.

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

Graham Peigh  1 , Mohamed Al-Kazaz  2 , Laura J Davidson  2 , Muhammed Gerçek  3 , Max Potratz  4 , S Christopher Malaisrie  2 , Rachel Finke  2 , Zhiying Meng  2 , Abigail S Baldridge  2 , Jing Gao  2 , Benjamin Magod  2 , Alexis Attinoto  2 , Akhil Narang  2 , Jyothy J Puthumana  2 , Linda Lee  2 , Matti Adam  5 , Jan Althoff  5 , Paul Cremer  2 , Rod S Passman  2 , Maria Isabel Körber  6 , Bradley P Knight  2 , Albert C Lin  2 , Volker Rudolph  5 , Charles J Davidson  7
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Free article
Multicenter Study

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

Graham Peigh et al. JACC Cardiovasc Interv. .
Free article

Abstract

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.

Keywords: cardiac implantable electronic device; defibrillation; lead revision; pacemaker; transcatheter tricuspid valve replacement; tricuspid regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Al-Kazaz has received research grant and speaking honoraria from Kiniksa Pharmaceuticals; and has received consulting fees from Edwards Lifesciences. Dr Gerçek has received funding from the Ruhr University Bochum (Advanced Clinician Scientist); and has served as a consultant for Edwards Lifesciences. Dr Passman has received research support from the American Heart Association grant #18SFRN34250013, National Institutes of Health grant UG3HL165065, Abbott, and Medtronic; speaker fees from Medtronic; and royalties from UpToDate. Dr Körber has received travel support and consultant honoraria from Edwards Lifesciences, Abbott Medical. and JenaValve. Dr Knight has received research grants or consulting fees from Abbott, Biotronik, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Rudolph has received research grants or consulting fees from Abbott Vascular and Edwards Lifesciences. Dr Davidson receives institutional grant support from and is an uncompensated advisor for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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