Key result
Transjugular leadless pacemaker implantation maintains stable 8-week pacing despite massive biatrial dilation.
Why the study?
Permanent pacing in patients with severe tricuspid regurgitation and distorted right heart anatomy is challenging, particularly when future valvular intervention is likely.
Is transjugular leadless pacemaker implantation feasible in a patient with massive biatrial dilation and severe tricuspid regurgitation?
Case Report (n=1)
Is transjugular leadless pacemaker implantation feasible in a patient with massive biatrial dilation and severe tricuspid regurgitation?
Transjugular implantation of a leadless pacemaker is a feasible alternative that avoids transvalvular leads in patients with distorted right heart anatomy and severe tricuspid regurgitation.
Alternative pacing strategies may be feasible in severe TR with distorted anatomy; leaves open need for prospective validation before wider use.
BACKGROUND: Permanent pacing in patients with severe tricuspid regurgitation (TR) and distorted right heart anatomy is challenging, particularly when future valvular intervention is likely. CASE SUMMARY: A 75-year-old man with permanent atrial fibrillation, prior mitral valve repair, massive biatrial enlargement, severe secondary TR, and symptomatic bradycardia with chronotropic incompetence required permanent pacing. Because conventional transvenous lead implantation was expected to be technically difficult and potentially unfavorable in the setting of severe TR and possible future valve intervention, a leadless pacemaker was selected. Owing to extreme atrial enlargement and altered right heart geometry, implantation was performed via the right internal jugular vein to improve catheter control and facilitate septal deployment. The procedure was successful, and pacing parameters remained stable at 8-week follow-up. DISCUSSION: Leadless pacing avoided a transvalvular lead and preserved future tricuspid treatment options. TAKE-HOME MESSAGE: Leadless transjugular pacing is a useful option in patients with distorted anatomy who may require future valvular repair.
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Wainstejn et al. (2026) conducted a case report in Symptomatic bradycardia with severe tricuspid regurgitation and massive biatrial enlargement (n=1). Transjugular leadless pacemaker implantation was evaluated on Procedural success and pacing parameter stability. Transjugular leadless pacemaker implantation was successful and maintained stable pacing parameters at 8 weeks in a 75-year-old man with massive biatrial dilation.
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