Key result
Leadless pacemaker implantation succeeds as a valve-sparing strategy for delayed AV block after TTVR.
Why the study?
Atrioventricular block requiring permanent pacemaker implantation occurs in 12.0% to 13.3% of patients after transcatheter tricuspid valve replacement without prior pacemaker.
Case Report (n=1)
Leadless pacemakers offer a viable, valve-sparing pacing option for patients developing delayed AV block after transcatheter tricuspid valve replacement.
May offer valve-sparing pacing in select post-TTVR AV block; hypothesis-generating and requires prospective validation.
BACKGROUND: Transcatheter tricuspid valve replacement (TTVR) is a minimally invasive treatment for severe tricuspid regurgitation. However, atrioventricular block (AVB) requiring permanent pacemaker implantation occurs in 12.0% to 13.3% of patients without a pacemaker. CASE SUMMARY: An 81-year-old man presented 7 days after TTVR with dyspnea and dizziness. Electrocardiography showed alternating AVB, and monitoring indicated a transient episode of complete AVB, suggesting a premonitory sign of delayed conduction disease after EVOQUE implantation. A leadless pacemaker (Micra VR) was implanted to avoid interference with the prosthetic tricuspid valve. The procedure was uneventful, and follow-up showed stable pacemaker parameters and preserved prosthetic valve function. DISCUSSION: This case review summarizes conduction disturbances after TTVR, pacing strategies, and postprocedural monitoring. In the absence of recommendations, pacemaker selection should be individualized, with leadless pacing representing a valve-sparing strategy. TAKE-HOME MESSAGES: Delayed AVB may occur after TTVR, with an alternating AVB as a premonitory sign. Leadless pacemakers offer a valve-sparing pacing option.
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Geerlings et al. (2026) conducted a case report in Delayed atrioventricular block after transcatheter tricuspid valve replacement (n=1). Leadless pacemaker (Micra VR) was evaluated on Procedural success and follow-up pacemaker parameters/prosthetic valve function. Implantation of a leadless pacemaker (Micra VR) was successfully performed as a valve-sparing strategy in an 81-year-old man with delayed atrioventricular block after TTVR.
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