Outcomes of Entrapped Right Ventricular Pacing or Defibrillator Leads Following Transcatheter Tricuspid Valve Replacement

BACKGROUND: In patients with a cardiac implantable electronic device (CIED) using a transvenous right ventricular (RV) lead, transcatheter tricuspid valve replacement (TTVR) results in RV lead entrapment. OBJECTIVES: The authors sought to evaluate outcomes of patients with pre-existing transvenous RV leads undergoing EVOQUE TTVR. METHODS: Patients with a CIED referred for TTVR at 3 centers were evaluated preoperatively by the heart team. Lead and clinical assessments were performed at baseline and in follow-up per local clinical practice. The primary outcome was the nature and incidence of major lead-related complications after TTVR. Secondary outcomes included changes in lead parameters after entrapment. RESULTS: Of 146 EVOQUE TTVR, 52 consecutive patients with entrapped RV leads (age 81 [77-85] years; 33 female patients (63.5%), lead dwell time 8.9 [3.3-13.6] years) were evaluated. Paravalvular leak was mild or less in 47 of 48 patients (98%) 30 days post-TTVR. Four patients had procedure-related lead complications: 1 intraprocedural RV lead dislodgement; 2 implantable cardioverter-defibrillator lead fractures 6- and 8-weeks post-TTVR; and 1 methicillin-resistant Staphylococcus aureus endocarditis 1 month post-TTVR. Among 46 complication-free patients with follow-up >30 days (356 [196-965] days), there were no other lead-related adverse events. Of the 33 patients without complications who had ≥1 CIED interrogation >30 days (424 [182-1,006] days) following TTVR, there was a significant decrease in lead impedance and increase in capture threshold on the final lead assessment, but no additional patients required lead revision. CONCLUSIONS: Following TTVR, most with entrapped RV leads remain free of lead-related complications. The need for urgent CIED revision due to RV lead dislodgment or failure is uncommon but may occur.