Fluoroscopic Risk Stratification of New-Onset Conduction Disturbances After Transcatheter Tricuspid Valve Replacement

BACKGROUND: New-onset conduction disturbances (NOCD) after transcatheter tricuspid valve replacement (TTVR) are often unpredictable. The membranous septum and conduction system are located beneath the noncoronary cusp (NCC). We used aortography to assess the position of TTVR device anchors relative to the NCC and underlying conduction system. CASE SUMMARY: Aortography was performed with a pigtail catheter after TTVR in long-axis and en face views of the transcatheter valve. Close proximity between the device anchors and the base of the NCC was found to be associated with NOCD and the need for a new permanent pacemaker. POTENTIAL PITFALLS: The length and position of the membranous septum may vary among patients. TAKE-HOME MESSAGES: Fluoroscopic assessment of TTVR device anchors in relation to the NCC as a marker of the conduction system may provide incremental risk stratification for NOCD and subsequent need for permanent pacemaker implantation after TTVR. Larger prospective studies are needed to validate this novel approach.