First-in-human combined transcatheter tricuspid valve implantation with leadless VDD pacemaker via left internal jugular approach

Figures

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  Figure 1. Right ventriculogram obtained after percutaneous tricuspid valve implantation showing trivial regurgitation.

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  Figure 2. Fluoroscopic views of Micra AV (Medtronic, St. Paul, MN) implantation procedure. A: Attempting to cross the newly implanted tricuspid valve with the Micra sheath over a stiff wire in the right pulmonary artery was unsuccessful, although B: the Micra delivery catheter was easily navigated through the tricuspid valve stent. The left internal jugular approach facilitated familiar catheter movements. C: Right anterior oblique (RAO) and D: steep left anterior oblique (LAO) views of positioning the Micra on the interventricular septum; note contrast “pancaking” on the septum. E: Unsheathing the Micra. F: Final position of the Micra in the right ventricle. Temporary pacing catheter in the left ventricle via retrograde aortic approach can also be seen throughout. CAUD = caudal angulation; CRAN = cranial angulation.

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  Figure 3. A: A 12-lead electrocardiogram from postimplant day 1, showing paced QRS morphology and intermittent atrioventricular (AV) synchrony. B: Sample from device interrogation 2 months after implant, demonstrating atrial undersensing (red stars) and oversensing (blue diamonds). C: Follow-up interrogation at 5 months after implant showing improved AV synchrony, with some persistent under- and oversensing, and variable timing of AM with the P wave. AM = atrial mechanical marker of A4 sensing; A. sensing = accelerometer channel for atrial sensing; MI = marker interval channel; VE = A3 window end; VP = ventricular pace.