Key result
Lead extraction with LBBAP reduces tricuspid regurgitation jet area by ~60% in severe TR.
Why the study?
Pacemaker lead-induced tricuspid regurgitation is a common complication after CIED implantation, and lead removal is a challenging procedure.
Does manual pacemaker lead extraction followed by left bundle branch area pacing reduce tricuspid regurgitation severity and heart failure symptoms in a patient with severe lead-induced tricuspid regurgitation?
Case Report (n=1)
No
Does manual pacemaker lead extraction followed by left bundle branch area pacing reduce tricuspid regurgitation severity and heart failure symptoms in a patient with severe lead-induced tricuspid regurgitation?
This case demonstrates that manual extraction of an 8-year-old passive-tip pacemaker lead followed by LBBAP implantation with a flexible Medtronic 3830 lead can safely resolve severe lead-induced tricuspid regurgitation and improve heart failure symptoms in carefully selected patients without valve calcification.
Answers are grounded in this paper and cite their sources.
May support manual extraction plus LBBAP for lead-induced TR in select cases; hypothesis-generating and leaves generalizability open.
Background: Pacemaker lead-induced tricuspid regurgitation is a common complication after cardiac implantable electronic device (CIED) implantation. Cardiac implantable electronic device lead removal is a challenge procedure. Case summary: A 72-year-old lady was admitted due to worsening heart failure. She had a history of permanent atrial fibrillation and had a permanent single-chamber pacemaker implanted 8 years ago due to complete heart block. Transthoracic echocardiography identified severe lead-related tricuspid regurgitation. The patient underwent successful lead extraction and received a new implantation of left bunch bundle area pacing. Transthoracic echocardiographic examination 2 days after the procedure showed a significant decrease of the tricuspid regurgitation. The patient also reported an improvement in heart failure symptoms. Discussion: Pacemaker lead-related tricuspid regurgitation introduces negative haemodynamic overload, carrying high risk for the development of heart failure and worse outcome. The present case shows a rapid relief of symptom and improvement of echocardiography findings, indicating the significance of mechanistic approach in the treatment of lead-related tricuspid mechanical interference.
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Chai et al. (2024) conducted a case report in Severe pacemaker lead-induced tricuspid regurgitation and worsening heart failure (n=1). Manual pacemaker lead extraction and left bundle branch area pacing (LBBAP) implantation was evaluated on Tricuspid regurgitation severity (regurgitation jet area) at 2 days post-procedure. Manual pacemaker lead extraction with LBBAP implantation reduced tricuspid regurgitation jet area from 20 cm² to 8.1 cm² at 2 days and NT-proBNP from 3253 to 738 pg/mL at 8 weeks.
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