Why the study?
Pacemaker dependency from conduction disorders is a frequent complication after transcatheter tricuspid valve replacement, requiring specialized knowledge and tailored acute and long-term pacing strategies.
This review provides a management algorithm for acute and long-term bradycardia following transcatheter tricuspid valve replacement, addressing a complication that affects roughly 25% of patients.
High pacemaker rates after EVOQUE TTVR require proactive monitoring; leaves optimal management algorithms open for prospective validation.
The recent development and approval of a transcatheter tricuspid valve represent a significant breakthrough in the management of patients with tricuspid regurgitation who are not suitable for existing invasive or interventional therapies. Despite promising outcomes, pacemaker dependency is a common consequence of transcatheter tricuspid valve replacement (TTVR). In the pivotal TRISCEND II randomized trial, conduction disorders requiring pacemaker implantation were the most frequent major adverse event at 30 days. Managing bradycardia following valve implantation in the tricuspid position requires specialized knowledge and tailored approaches for both temporary and permanent pacing. This necessity is driven by the specific design features of the valves and the evolving choices of valve-sparing pacing strategies. Our aim is to summarize these unique challenges to support both heart team members and nonelectrophysiology health care professionals performing TTVR, as well as intensive care unit and bradycardia specialists who may be unfamiliar with the distinctive characteristics of TTVR. Bradycardia due to atrioventricular (AV) conduction delay, requiring new pacemaker implantation, affects approximately 1 in 4 patients receiving the bioprosthetic EVOQUE valve and is also common with other TTVR devices. This review summarizes current knowledge on TTVR-associated bradycardia and a management algorithm for both acute and long-term settings, highlighting specialized considerations for patients undergoing TTVR.
No takes yet. Share an insight, caveat, or question.
Hain et al. (2025) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: