Managing Implanted Cardiac Electronic Devices in Patients With Severe Tricuspid Regurgitation: JACC State-of-the-Art Review

Rebecca T Hahn; Bruce Larry Wilkoff; Susheel Kodali; Ulrika Maria Birgersdotter-Green; Gorav Ailawadi; Karima Addetia; Martin Andreas; Angelo Auricchio; Frederick Ehlert; Isaac George; Aakriti Gupta; Rachel Harrison; Edwin C Ho; Fred Kusumoto; Azeem Latib; Patrick O'Gara; Kristen K Patton; Sean Pinney; Emily P Zeitler; Michael J Mack; Martin B Leon; Laurence M Epstein; Heart Valve Collaboratory and Heart Rhythm Society

doi:10.1016/j.jacc.2024.02.045

Managing Implanted Cardiac Electronic Devices in Patients With Severe Tricuspid Regurgitation: JACC State-of-the-Art Review

J Am Coll Cardiol. 2024 May 21;83(20):2002-2014. doi: 10.1016/j.jacc.2024.02.045.

Authors

Rebecca T Hahn¹, Bruce Larry Wilkoff², Susheel Kodali³, Ulrika Maria Birgersdotter-Green⁴, Gorav Ailawadi⁵, Karima Addetia⁶, Martin Andreas⁷, Angelo Auricchio⁸, Frederick Ehlert³, Isaac George³, Aakriti Gupta⁹, Rachel Harrison¹⁰, Edwin C Ho¹¹, Fred Kusumoto¹², Azeem Latib¹¹, Patrick O'Gara¹³, Kristen K Patton¹⁴, Sean Pinney¹⁵, Emily P Zeitler¹⁶, Michael J Mack¹⁷, Martin B Leon¹⁸, Laurence M Epstein¹⁹; Heart Valve Collaboratory and Heart Rhythm Society

Affiliations

¹ Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA. Electronic address: [email protected].
² Cleveland Clinic, Cleveland, Ohio, USA.
³ Columbia University Irving Medical Center, New York, New York, USA.
⁴ University of California-San Diego, San Diego, California, USA.
⁵ University of Michigan, Ann Arbor, Michigan, USA.
⁶ University of Chicago Medicine, Chicago, Illinois, USA.
⁷ MedUni, Vienna, Austria.
⁸ Istituto Cardiocentro Ticino, Lugano, Switzerland.
⁹ Cedars Sinai Medical Center, Los Angeles, California, USA.
¹⁰ Medstar Health Research Institute, Washington, DC, USA.
¹¹ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹² Mayo Clinic, Jacksonville, Florida, USA.
¹³ Brigham & Women's Hospital, Boston, Massachusetts, USA.
¹⁴ U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
¹⁵ Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁶ Dartmouth Health, Lebanon, New Hampshire, USA.
¹⁷ Baylor Scott & White Health, Dallas, Texas, USA.
¹⁸ Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
¹⁹ Northwell Health, New York, New York, USA.

PMID: 38749619
DOI: 10.1016/j.jacc.2024.02.045

Abstract

Orthotopic transcatheter tricuspid valve replacement (TTVR) devices have been shown to be highly effective in reducing tricuspid regurgitation (TR), and interest in this therapy is growing with the recent commercial approval of the first orthotopic TTVR. Recent TTVR studies report preexisting cardiac implantable electronic device (CIED) transvalvular leads in ∼35% of patients, with entrapment during valve implantation. Concerns have been raised regarding the safety of entrapping leads and counterbalanced against the risks of transvenous lead extraction (TLE) when indicated. This Heart Valve Collaboratory consensus document attempts to define the patient population with CIED lead-associated or lead-induced TR, describe the risks of lead entrapment during TTVR, delineate the risks and benefits of TLE in this setting, and develop a management algorithm for patients considered for TTVR. An electrophysiologist experienced in CIED management should be part of the multidisciplinary heart team and involved in shared decision making.

Keywords: cardiac implantable electronic device; transcatheter tricuspid valve replacement; tricuspid regurgitation.

Publication types

Review

MeSH terms

Defibrillators, Implantable* / adverse effects
Heart Valve Prosthesis Implantation / adverse effects
Heart Valve Prosthesis Implantation / methods
Humans
Pacemaker, Artificial* / adverse effects
Severity of Illness Index
Tricuspid Valve Insufficiency* / surgery