Successful Extraction of Entrapped CIED Lead After TTVR

BACKGROUND: Transcatheter tricuspid valve replacement (TTVR) has emerged as a therapeutic option for patients with symptomatic severe tricuspid regurgitation. Right ventricular (RV) leads from pre-existing cardiac implantable electronic devices are entrapped during TTVR device implantation. CASE SUMMARY: An 83-year-old woman with a dual-chamber cardiac implantable electronic device underwent TTVR in 2022. The procedure resulted in entrapment of the RV lead. After TTVR, the increase in lead impedance raised concern for lead failure, prompting consideration of a leadless pacemaker. During this procedure, the entrapped lead was extracted without causing malposition of the TTVR device. DISCUSSION: Extraction of entrapped leads after TTVR may be feasible in experienced centers after cautious deliberation. Nevertheless, pre-emptive lead extraction should be considered to minimize the risk of unsuccessful extraction or serious complications. TAKE-HOME MESSAGE: Extraction of entrapped RV leads without causing TTVR device malposition may be feasible, and leadless pacemakers can be considered a technically viable alternative for RV pacing in TTVR.