Safety and Feasibility of Left Bundle Branch Area Pacing Following Transcatheter Tricuspid Valve Replacement

BACKGROUND: Transcatheter tricuspid valve replacement (TTVR) is a novel therapy for severe tricuspid regurgitation. However, conduction disturbances requiring pacemaker implantation occur in up to 24.7% of patients. Left bundle branch area pacing (LBBAP) has not been systematically evaluated post-TTVR, where lead passage across the prosthesis may compromise valve integrity. The objective of this paper was to report the feasibility, safety, and performance of LBBAP after TTVR. CASE SUMMARY: Two pacemaker-naïve patients requiring pacing post-TTVR were retrospectively analyzed. DISCUSSION: Both patients underwent TTVR and developed high-grade atrioventricular block within 72 hours. LBBAP was successful in both cases with no procedural-related complications. At 30 days, pacing parameters remained unchanged with no device-related adverse events. Echocardiography at 1 and 30 days demonstrated ≤ mild tricuspid regurgitation, no lead-valve interaction, and stable right ventricular function. TAKE-HOME MESSAGES: LBBAP post-TTVR is feasible with excellent short-term safety and performance while maintaining valve integrity. Our series reinforces its safety and adds systematic echocardiographic follow-up.