Pacemaker lead implantation in a patient with transcatheter bicaval prosthesis

Transcatheter tricuspid valve (TTV) intervention is a promising therapeutic alternative for high-risk patients with severe tricuspid regurgitation. Transcatheter tricuspid valve replacement in heterotopic position (bicaval valve implantation: TricValve^®) is one of these novel available devices. The implantation of pacing leads can be significantly more challenging in these patients.

We present an 80-year-old woman referred for percutaneous implantation of bicaval valve prosthesis TricValve^®. She had a history of permanent atrial fibrillation. The TricValve^® implantation procedure was uncomplicated, but the patient presented with complete atrioventricular block on the 6th day after TTV, and permanent pacing was required.

Angiography was performed to assess the permeability of the right upper limb venous system (Panel A). The left innominate vein drainage into the superior vena cava was very close to the valvulated structure of the TricValve^®. Therefore, pacemaker implantation on the right side was chosen. An active fixation ventricular lead was introduced across the frame of the superior vena cava prosthesis into the right ventricle apex (Panels A and B).

This is the first case of intraventricular lead implantation after bicaval TTV. Lead implantation through the frame of the prosthesis is feasible and safe.

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