Transjugular leadless pacemaker implantation after transcatheter tricuspid valve replacement with a biological prosthetic valve: a case report

Transcatheter tricuspid valve replacement (TTVR) is an emerging therapy for patients with severe tricuspid regurgitation who are not candidates for surgery. Post-procedural atrioventricular (AV) block may necessitate permanent pacing, but traditional transvenous systems are often contraindicated in the setting of a tricuspid prosthetic valve. Leadless pacemakers represent a valuable alternative, though anatomic changes after valve implantation may challenge standard transfemoral delivery.

We report the case of an 82-year-old woman who underwent successful TTVR for severe tricuspid regurgitation. Three days later, she developed complete AV block requiring permanent pacing. Attempts to implant a leadless pacemaker via the right femoral vein failed due to altered tricuspid valve orientation. A transjugular approach enabled effective deployment of the device on the interventricular septum.

High-degree AV block is not an infrequent complication occurring after TTVR. Pacing strategies to spare further valve disturbances are mainly represented by single-lead pacing via the coronary sinus and leadless cardiac pacemaker implantation. An individualized approach based on anatomical considerations is essential in the context of complex structural heart interventions.

The transjugular approach can serve as a reliable alternative for leadless pacemaker delivery in patients with tricuspid biological prosthetic valve, offering favourable curvature and access in anatomically challenging cases.