Strategy for pacemaker implantation following transcatheter tricuspid valve replacement: A real world single centre experience

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BACKGROUND: High-degree AV-Block requiring pacemaker (PM) implantation is a frequent complication after transcatheter tricuspid valve replacement (TTVR), which represents a relative contra-indication to standard right ventricular (RV) lead placement. We report our experience in this patient cohort and compared different PM strategies prioritising interventional valve sparing options. METHODS: Consecutive patients treated with the EVOQUE system (Edwards Lifesciences) at our centre between January 2024 and May 2025 were included in this retrospective single centre analysis. Successful implantation of a valve sparing PM and feasibility of PM implantation were assessed. RESULTS: This analysis included 39 patients (mean age 77.3 years, 74.4% women, 8 patients with pre-existing PM). High-degree AV-Block requiring PM implantation occurred in 28.2% in our cohort (11/39 patients), the de-novo PM implantation rate was 35.5% (11/31 patients). Complete or incomplete right bundle branch block (RBBB) was the most frequent conduction system disorder after TTVR (11/31 patients). Median time from TTVR to PM implantation was six days [IQR: 2.5-13]. PM implantation was feasible in 11/11 patients (100%), no surgical lead placement was necessary. Implantation of a valve sparing PM was successful in 10/11 patients (90.9%). Leadless PM were implanted in 3/11, coronary sinus lead PM in 7/11 patients. In one patient both interventional valve sparing PM approaches failed and a standard RV lead across the EVOQUE system was implanted. CONCLUSION: High-degree AV-Block after TTVR is a frequent complication and PM implantation in these patients demands careful consideration. Valve sparing PM approaches appear feasible and were achieved with reasonable success rates in our cohort.

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