Canadian Journal of Cardiology

Pacemaker Lead Entrapment Complicating Heterotopic Transcatheter Tricuspid Valve Implantation

Published:April 29, 2021DOI:
      A 75-year-old woman presented with progressive dyspnea and peripheral edema. Her history included atrial fibrillation, mechanical mitral prosthesis, dual-chamber pacemaker, and chronic kidney disease. Echocardiography revealed severe functional tricuspid regurgitation, originating from the posteroseptal commissure, with mild right ventricular dysfunction (Fig. 1A). After heart team review, the patient was deemed inoperable and unsuitable for transcatheter edge-to-edge repair or annuloplasty because of anticipated mechanical interference of the pacemaker lead. Heterotopic caval valve implantation (CAVI) with TricValve (Products + Features GmbH, Vienna, Austria) was planned.
      Figure 1
      Figure 1(A) Baseline echocardiography showing massive tricuspid regurgitation. (B) Two-dimensional/3-D transesophageal echocardiography showing noncoaptation of the inferior vena cava leaflets (red arrowheads) due to pacemaker lead (white arrowheads) interference. (C) Fluoroscopic loop-shaped lead after caval valve implantation. (D, E) Percutaneous lead capture and partial externalization around the device. (F-H) Three-dimensional computed tomography modelling illustrating the acute bend (asterisk) of the pacemaker lead before (F) and after (G) and (H) balloon-expandable valve implantation. (I, J) Valve-in-valve implantation within the inferior vena cava valve, without residual leak. (K) Coaptation restoration after SAPIEN valve (Edwards Lifesciences, Irvine, CA) implantation.
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        • Asmarats L
        • Puri R
        • Latib A
        • Navia JL
        • Rodes-Cabau J
        Transcatheter tricuspid valve interventions: landscape, challenges, and future directions.
        J Am Coll Cardiol. 2018; 71: 2935-2956