To jail or to extract? Management of patients with transvenous pacing leads undergoing transcatheter tricuspid valve intervention

PURPOSE OF REVIEW: Uncertainly exists regarding lead management of patients with cardiac implantable electronic devices (CIEDs) who will undergo transcatheter tricuspid valve intervention (TTVI). Using published data describing the impact of TTVI on lead function, this review provides a framework for clinicians when deciding whether transvenous pacing leads should be retained ("jailed") or extracted for patients undergoing TTVI. RECENT FINDINGS: Among patients with CIEDs who underwent transcatheter tricuspid valve replacement, the incidence of lead malfunction requiring lead revision was ~5%. Most lead abnormalities occurred within 24 h postprocedure but late cases (>3 months) also occurred. The rate of lead malfunction is lower (~1%) for patients who underwent transcatheter edge-to-edge tricuspid repair. Head-to-head comparison between devices is lacking. The presence of transvenous leads did not appear to adversely affect procedural and clinical outcomes of patients undergoing TTVI. SUMMARY: When clinicians decide on whether lead jailing or extraction should be pursued for patients undergoing TTVI, a personalized approach is required with consideration of the following aspects: the lead's impact on procedural success, the benefits and risks of lead extraction, ongoing and future requirement for pacing and/or defibrillation, and the future risk of extraction if the lead is jailed.