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

Leadless pacemakers (LPMs) reduce many 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.

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, the anterior papillary muscle became entrapped between the delivery sheath and the leadless pacemaker during deployment. Subsequent retrieval resulted in papillary muscle rupture and severe TR. The patient later underwent transvenous pacemaker implantation and recovered with medical therapy. He was transferred to a rehabilitation hospital without requiring additional intervention for tricuspid valve regurgitation.

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.