Device‐Sparing Posteroseptal Trans‐Tricuspid Lead Implantation After Tricuspid TEER: A Three‐Case Device Rounds Report

ABSTRACT Transvenous right ventricular lead implantation after tricuspid transcatheter edge‐to‐edge repair (T‐TEER) may be challenging because of potential interaction with implanted repair devices, grasped leaflets, or the repaired coaptation zone. We describe three patients requiring transvenous pacemaker or implantable cardioverter‐defibrillator implantation after T‐TEER with TriClip or PASCAL systems. In each case, the posterior‐most T‐TEER device was used as a fluoroscopic landmark to guide lead passage inferior and posterior to the device toward an unobstructed posteroseptal residual orifice. Pacemaker leads were delivered using catheter‐and‐wire crossing followed by advancement of a long slittable sheath, whereas the defibrillator lead required direct shaping and fluoroscopic manipulation because of sheathlead incompatibility. Implantation was successful in all three patients. During 612 months of follow‐up, tricuspid regurgitation remained mild or trace, mean transtricuspid gradients ranged from 1.8 to 2.1 mmHg, and no echocardiographic leadleaflet or leaddevice interaction or lead‐related complications were observed. This fluoroscopy‐guided, device‐sparing strategy may represent a practical option when transvenous right ventricular lead implantation is clinically necessary after T‐TEER.