Tricuspid valve disease and cardiac implantable electronic devices

Abstract

The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.

Tricuspid Valve Leaflets–Lead Interaction

“…When 4D-CTA is performed with proper acquisition protocol, including an ECG-gated retrospective acquisition covering the whole cardiac cycle without dose modulation, proper right-sided contrast material enhancement, and dedicated post-processing software to reconstruct and provide a systematic analysis, it could play a pivotal complementary role to define the nature of lead-leaflet interaction, 1 , 4 as shown in this case series. Of particular importance for improved 4D-CTA imaging is to have high temporal resolution from dual-source system scanners, which also allow for absolute millisecond reconstructions mitigating motion and streak artifacts, commonly seen in these patients with CIED-related TR.…”

“…Emerging data regarding the prevalence and prognostic role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) have supported its clinical relevance. 1 , 2 Although CIED-related TR diagnosis has improved recently, specific anatomical and causal relationships between TR and CIEDs are complex to determine. However, addressing this question may be of pivotal importance, particularly considering novel transcatheter edge-to-edge valve repair (TEER) and transcatheter valve (TV) replacement therapies, as it relates to procedural lead management.…”

Contemporary evaluation and treatment of tricuspid regurgitation

“…The presence of hardware such as annuloplasty bands, bioprosthetic valves, permanent pacemaker (PPM), or implantable cardioverter defibrillation (ICD) must also be identified ( Figure 1D ) as these can adhere, perforate, or restrict leaflet motion, all of which pose technical challenges during treatment intervention ( 32 ). The location of the lead across the TV, its mobility and relation to the leaflet, and subvalvular apparatus are all important for TEER.…”

“…Imaging of the TV in the presence of hardware therefore is especially important and can pose its own technical challenges. TEE and 3D image reconstruction, along with multiplanar imaging, allow for the anatomy to be imaged on both the atrial and ventricular sides, visualize lead trajectory, and leaflet motion ( 32 ). Such information can best be acquired by the transgastric view or 3D volume-rendered equivalent ( 30 ).…”

Recent Advances across the Spectrum of Heart Failure and Heart Transplant

“…As with ICD and CRT, cardiac contractility modulation (CCM) therapy is provided by leads positioned in the right ventricle. Recently, the interplay between cardiac implantable electronic devices (CIEDs) and tricuspid regurgitation (TR) has been reviewed and recognized as a distinct clinical entity that increased the risk of death [ 5 ]. Herein, a unique prospective study aimed to assess TR after CCM implantation was published by Masarone et al (Contribution 7).…”