Cardiac implantable electronic devices in patients referred for transcatheter tricuspid edge-to-edge repair: clinical characteristics and impact on procedure eligibility

ABSTRACT Background Tricuspid transcatheter edge-to-edge repair (T-TEER) has become an established therapeutic option for patients with severe tricuspid regurgitation (TR). However, data regarding the qualification process for T-TEER in patients with cardiac implantable electronic devices (CIED) are limited. Methods This retrospective, multicenter study included consecutive patients with severe TR referred between January and December 2024 to six tertiary centers (five in Poland, one in Italy) for T-TEER screening. Echocardiographic assessment followed current recommendations using a five-grade TR severity scale. In CIED carriers, the relationship between the tricuspid valve and the lead was classified as CIED-related (direct interference) or CIED-associated (no causal interaction). Heart teams evaluated all cases, recording qualification status and reasons for disqualification. Results Among 271 patients (mean age 77 ± 9 years, 58.3% female), 113 (41.7%) had a CIED. Compared with non-CIED patients, CIED carriers showed higher rates of diabetes mellitus (35.4% vs. 17.1%), chronic kidney disease (70.8% vs. 54.4%), and previous CABG (13.3% vs. 4.4%), and exhibited lower LV ejection fraction (50.5% vs. 57.0%, all p < 0.05). Overall, 56.5% were qualified for T-TEER, with no significant difference between CIED and non-CIED groups (54.0% vs. 58.3%, p = 0.487). Among CIED patients, 37 (32.7%) had CIED-related TR, characterized by more severe TR (EROA 0.90 vs. 0.60 cm², p = 0.017) but similar qualification rates (59.5% vs. 52.7%, p = 0.500). Conclusions CIED carriers with severe TR represent a more complex and symptomatic population, yet the presence of a CIED does not affect eligibility for T-TEER. The high prevalence of CIED-related TR underscores the growing clinical relevance of this condition and highlights the need for prospective multicenter studies to refine patient selection and treatment strategies.