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

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.

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Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Funding Support and Author Disclosures Dr Hahn has received speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic, Philips Healthcare, and Siemens Healthineers; and has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic, and Novartis. Dr Wilkoff has served as a consultant, speaker, and researcher for Abbott, Biotronik, Boston Scientific, Medtronic, Philips, Cook, and Xcardia. Dr Kodali has served on the scientific advisory board for Microinterventional Devices, Dura Biotech, Thubrikar Aortic Valve, and Supira; has served as a consultant for Meril Lifesciences, Admedus, Medtronic, and Boston Scientific; has served on the steering committee for Edwards Lifesciences and Abbott Vascular; has received honoraria from Meril Lifesciences, Admedus, Abbott Vascular, and Dura Biotech; and has owned equity in Dura Biotech, Thubrikar Aortic Valve, Supira, and MID. Dr Birgersdotter-Green has received speaker honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, and Philips Healthcare. Dr Ailawadi has served as a consultant for Edwards Lifesciences, Medtronic, Abbott Structural, Philips Healthcare, Anteris, W.L. Gore & Associates, Jena Valve, and Arthrex. Dr Andreas has served as a proctor and consultant for and has received speaker honoraria from Edwards Lifesciences, Abbott, and Medtronic; and has received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI Solutions. Dr Auricchio has received consulting fees from Boston Scientific, Cairdac, EP Solutions, Medtronic, Philips, Radcliffe Publishers, and XSpline; has received payment or honoraria from Boston Scientific, Medtronic, Microport CRM, and Philips; and has patents with Boston Scientific, Biosense Webster, and Microport CRM. Dr George has received consulting honoraria from Zimmer Biomet, Atricure, Neosurgery, Neptune Medical, Abbvie, Johnson & Johnson, DurVena, Boston Scientific, Edwards Lifesciences, Medtronic, Help-TheraX, 3ive, Encompass, Summus Medical, Abbott St Jude Medical, BCI, and Xeltis; has served on the advisory board for Edwards Surgical, Medtronic Surgical, Medtronic Structural Mitral & Tricuspid, Trisol Medical, Valcare Medical, DurVena, Abbvie, Johnson & Johnson, Foldax Medical, Zimmer Biomet, Neosurgery, Abbvie, Boston Scientific, Summus Medical, and BCI; has held equity in Valcare Medical, DurVena, CardioMech, VDyne, MitreMedical, MITRx, and BCI; and has received institutional funding to Columbia University from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. Dr Harrison has served as a speaker for Philips Healthcare. Dr Ho has received institutional consulting contracts for which he receives no direct compensation with Edwards Lifesciences, Abbott, and GE Healthcare; has received research support from Philips; and has served as an advisor for which he receives no direct compensation for Medtronic, NeoChord, Tioga, Laza Medical, ValGen, Half Moon Medical, VDyne, and Anteris. Dr Latib has served as a consultant and/or advisory board member for Edwards Lifesciences, Abbott, Medtronic, Boston Scientific, Shifamed, NeoChord, VDyne, and Philips. Dr O’Gara has received consulting agreements from Edwards Lifesciences, and Medtronic. Dr Pinney has received consulting fees from Abbott, ADI, Ancora Heart, CareDx, Cordio, Medtronic, Procyrion, Restore Medical, Transmedics, and ValGen; and has received speaker fees from Impulse Dynamics. Dr Zeitler has received consulting and travel support from Medtronic and Biosense Webster; has received nonfinancial research support from Biosense Webster and Sanofi; and has received research support from the National Institutes of Health. Dr Mack has served as the co-principal investigator or study chair for clinical trials sponsored by Abbott, Edwards Lifesciences, and Medtronic. Dr Leon has received institutional research support from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has served as a consultant or advisory board member for Abbott, Boston Scientific, W.L. Gore & Associates, Medtronic, and Meril Life, Dr Epstein has received consultant fees from Boston Scientific, Medtronic, and The Spectranetics Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.