Feasibility of Left Bundle Branch Pacing and Management of Jailed Leads After Transcatheter Tricuspid Valve Implantation

Atrioventricular conduction disturbances and the need for cardiac implantable electronic device (CIED) therapy are frequently required after transcatheter tricuspid valve implantation (TTVI). The interaction between the annulus, transcatheter heart valve and the leads is often complex and the optimal management under debate. We prospectively included 36 patients undergoing TTVI between June 2021 and January 2025. 14 patients had a preexisting CIED. 11 patients experienced right ventricular lead-jailing without signs for early or delayed lead failure after one year, one patient underwent lead extraction and two patients had a leadless pacemaker. In four patients, a pacemaker in LBBAP was successfully implanted due to new-onset postoperative atrioventricular block. The device measurements as well as the valve function remained stable over a follow-up of at least one up to 2.5 years with persistent LBB-capture. This case series demonstrates that LBBAP following TTVI is feasible with encouraging early outcomes. Careful patient selection and dedicated follow-up are essential for patients with CIED treated with TTVI.