Coronary Sinus Lead Entrapment During Transcatheter Tricuspid Valve Replacement

BACKGROUND: Entrapment of transvenous pacing leads resulting in lead failure is a well-known complication of transcatheter tricuspid valve replacement (TTVR). Current guidelines advise preemptive alternative pacing strategies that do not cross the tricuspid valve in pacing-dependent patients. CASE SUMMARY: A pacing-dependent patient with a cardiac resynchronization therapy with defibrillator device underwent TTVR. He subsequently developed simultaneous fractures of his right ventricular and left ventricular leads, necessitating an epicardial pacing system. DISCUSSION: Transvenous left ventricular pacing leads coursing near the tricuspid valve annulus can also be at risk of entrapment during TTVR, resulting in sudden lead failure. TAKE-HOME MESSAGES: Coronary sinus lead entrapment is a potential complication of TTVR, especially for leads coursing near the tricuspid valve annulus and/or when a large-diameter valve is deployed. TTVR in pacing-dependent patients in whom a pre-existing coronary sinus lead is the sole or backup means of pacing require meticulous attention during valve placement and close follow-up.