Navigating Challenges in Tricuspid Transcatheter Therapies for Patients with CIED Leads: Review of Clinical Evidence and Procedural Insights

Transcatheter tricuspid valve interventions, including Tricuspid Transcatheter Edge-to Edge Repair (T-TEER) and Transcatheter Tricuspid Valve Replacement (TTVR), have emerged as effective therapies for patients with severe Tricuspid Regurgitation (TR) and Cardiovascular Implantable Electronic Devices (CIEDs). This review examines outcomes in CIED patients undergoing these interventions. Evidence from registries, trials, and case reports consistently shows that both T-TEER and TTVR are feasible and safe in patients with transvalvular leads. These procedures achieve significant TR reduction, symptom improvement, and enhanced quality of life. Lead dysfunction or procedural complications related to the presence of transvalvular leads are uncommon, and routine lead extraction is generally unnecessary. Technical considerations for success include careful echocardiographic evaluation, strategic device placement, and multidisciplinary planning. In challenging cases, lead repositioning or extraction with leadless pacing can be considered. Current evidence supports that transcatheter tricuspid interventions should not be withheld from carefully selected patients with CIED leads. Keywords Tricuspid regurgitation • Tricuspid transcatheter edge-to-edge repair • Transcatheter tricuspid valve replacement • Cardiovascular implantable electronic devices