Key result
Transjugular leadless pacing enables successful implantation after failed transfemoral access post-TTVR.
Why the study?
Post-procedural AV block after transcatheter tricuspid valve replacement often requires permanent pacing, but traditional transvenous systems are contraindicated with tricuspid prosthetic valves and anatomical changes may challenge standard leadless pacemaker delivery.
Case Report (n=1)
The transjugular approach is a reliable alternative for leadless pacemaker delivery in patients with a tricuspid biological prosthetic valve when the standard transfemoral route is anatomically challenging.
Case suggests transjugular leadless pacing as alternative post-TTVR after failed transfemoral; leaves open safety and efficacy in larger cohorts.
Background: Transcatheter tricuspid valve replacement (TTVR) is an emerging therapy for patients with severe tricuspid regurgitation who are not candidates for surgery. Post-procedural atrioventricular (AV) block may necessitate permanent pacing, but traditional transvenous systems are often contraindicated in the setting of a tricuspid prosthetic valve. Leadless pacemakers represent a valuable alternative, though anatomic changes after valve implantation may challenge standard transfemoral delivery. Case summary: We report the case of an 82-year-old woman who underwent successful TTVR for severe tricuspid regurgitation. Three days later, she developed complete AV block requiring permanent pacing. Attempts to implant a leadless pacemaker via the right femoral vein failed due to altered tricuspid valve orientation. A transjugular approach enabled effective deployment of the device on the interventricular septum. Discussion: High-degree AV block is not an infrequent complication occurring after TTVR. Pacing strategies to spare further valve disturbances are mainly represented by single-lead pacing via the coronary sinus and leadless cardiac pacemaker implantation. An individualized approach based on anatomical considerations is essential in the context of complex structural heart interventions. Conclusion: The transjugular approach can serve as a reliable alternative for leadless pacemaker delivery in patients with tricuspid biological prosthetic valve, offering favourable curvature and access in anatomically challenging cases.
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Fortuna et al. (2025) conducted a case report in Severe tricuspid regurgitation and post-procedural complete AV block (n=1). Transjugular leadless pacemaker implantation was evaluated on Successful device deployment. Transjugular leadless pacemaker implantation was successfully performed in 1 patient with complete AV block following transcatheter tricuspid valve replacement after a failed transfemoral approach.
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