Massive tricuspid regurgitation caused by iatrogenic papillary muscle rupture during leadless pacemaker retrieval: a case report

Abstract Background Leadless pacemakers (LPMs) reduce complications associated with transvenous systems; however, tricuspid regurgitation (TR) caused by mechanical interference after LPM implantation has been reported. We describe a rare case of massive TR caused by papillary muscle rupture during LPM deployment and retrieval. Case summary An 86-year-old man presented with syncope due to complete atrioventricular block. Because of his advanced age and limited activities of daily living, a leadless pacemaker was selected. During deployment, anterior papillary muscle became entrapped between the delivery sheath and the leadless pacemaker while recapturing. Subsequent retrieval resulted in papillary muscle rupture leading severe TR. The patient later underwent transvenous pacemaker implantation and recovered with medical therapy. Discussion This case highlights a previously unreported mechanism of TR during LPM implantation—papillary muscle entrapment and rupture during device retrieval—which can lead to catastrophic tricuspid valve dysfunction.