Key result
Leadless pacemaker implantation through a bioprosthetic tricuspid valve shows feasibility without worsening regurgitation at 6 months.
Why the study?
Very limited data exist about the feasibility and safety of leadless pacemaker implantation through a bioprosthetic tricuspid valve.
Does leadless pacemaker implantation through a bioprosthetic tricuspid valve prevent mechanical interference and valve dysfunction in patients with epicardial pacemaker failure?
Case Report (n=2)
No
Does leadless pacemaker implantation through a bioprosthetic tricuspid valve prevent mechanical interference and valve dysfunction in patients with epicardial pacemaker failure?
Leadless pacemaker implantation through a tricuspid bioprosthesis appears feasible and safe in highly skilled hands, offering an alternative when epicardial pacing fails.
May offer alternative in epicardial lead failure with bioprosthetic tricuspid valves; hypothesis-generating and requires larger prospective studies.
BACKGROUND: Leadless pacemaker (LP) therapy has been proved effective in cases where traditional transvenous right pacing (TRP) failed. TRP through a bioprosthetic tricuspid valve (BTV) has always been considered an unpreferable solution because of possible deleterious effect of permanent pacing leads on BTV function and specifically on tricuspid regurgitation (TR). Very limited data exist about the feasibility and safety of LP implantation in this setting. METHODS: We describe two cases of LP implantation through BTV in patients with failure of epicardial pacemaker implanted after cardiac surgery. The focus is on technical description of the procedure and on electrical and echocardiographic evaluation at implantation and at the follow-up. RESULTS: In both cases, skilled and careful handling of the delivery system as well as proper use of X-ray oblique views was determinant for atraumatic successful valve crossing. Likewise, an accurate selection of the deployment site inside the right ventricle, far enough from the valve to avoid valvular dysfunction, was important for successful implantation. Electrical parameters of LP were satisfying at implantation and at the follow-up. The echocardiogram after implantation and at the follow-up showed no mechanical interference of LP with prosthetic valve, no significant TR, and absence of significant changes in the biventricular function. CONCLUSION: Our data seem to support feasibility and safety of this type of procedure in skilled hands, allowing efficacious pacing without valvular dysfunction or right ventricular (RV) physiology impairment.
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Morani et al. (2021) conducted a case report in Epicardial pacemaker malfunction with bioprosthetic tricuspid valve (n=2). Leadless pacemaker (Micra) was evaluated on Echocardiographic and electrical evaluation at implantation and follow-up. Leadless pacemaker implantation through a bioprosthetic tricuspid valve was successfully performed in two cases without mechanical interference or worsening tricuspid regurgitation at 6 months.
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