Utility of a Leadless Pacemaker as a Backup to Left Ventricle–only Pacing in a Patient with Prior Device-related Severe Tricuspid Regurgitation

Abstract

The contribution of endocardial cardiac device leads to severe tricuspid regurgitation (TR) has become increasingly recognized. Current strategies for treating cardiac device lead-related TR have limitations. We present a case of a pacemaker-dependent patient with severe TR as a complication of multiple cardiac device leads who underwent laser lead extraction, which was followed by implantation of a dual-chamber pacemaker with a coronary sinus lead for left ventricular pacing and a leadless transcatheter pacemaker for backup right ventricular (RV) pacing. This report represents one of the first cases of a leadless pacemaker implanted for RV backup pacing, highlighting the possibility of future biventricular pacing therapy (with a leadless pacemaker in VVT mode) without endocardial leads crossing the tricuspid valve.

Lead-related tricuspid regurgitation and ventricle dysfunction: Current management and future perspectives

“…[63][64][65] A leadless pacemaker may also be used in combination with an sICD, or a lead can be implanted into the coronary sinus for biventricular pacing. 66 Some reports have shown good results with pericardial, extrapleural and substernal placement of defibrillator coils, separately or in conjunction with epicardial pacing leads, although their implantation requires employing surgical techniques. 53…”