Pacing and Defibrillation Consideration in the Era of Transcatheter Tricuspid Valve Replacement.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Cardiology Reports Pub Date : 2024-05-01 Epub Date: 2024-03-16 DOI:10.1007/s11886-024-02032-7
Devinder S Dhindsa, Wissam Mekary, Mikhael F El-Chami
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Abstract

Purpose of review: Tricuspid regurgitation is a commonly encountered valvular pathology in patients with trans-tricuspid pacing or implantable cardioverter-defibrillator leads. Transcatheter tricuspid valve interventions are increasingly performed in patients at high surgical risk. Implantation of these valves can lead to the "jailing" of a trans-tricuspid lead. This practice carries both short- and long-term risks of lead failure and subsequent infection without the ability to perform traditional transvenous lead extraction. Herein, this manuscript reviews available therapeutic options for lead management in patients undergoing transcatheter tricuspid valve interventions.

Recent findings: The decision to jail a lead may be appropriate in certain high-risk cases, though extraction may be a better option in most cases given the variety of options for re-implant, including leadless pacemakers, valve-sparing systems, epicardial leads, leads placed directly through prosthetic valves, and the completely subcutaneous implantable-defibrillator. A growing number of patients meet the requirement for CIED implantation in the United States. A significant proportion of these patients will have tricuspid valve dysfunction, either related to or independent of their transvenous lead. As with any percutaneous intervention that has shown efficacy, the role of TTVI is also likely to increase as this therapy advances beyond the investigational phase. As such, the role of the heart team in the management of these patients will be increasingly critical in the years to come, and in those patients that have pre-existing CIED leads, we advocate for the involvement of an electrophysiologist in the heart team.

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经导管三尖瓣置换术时代的起搏和除颤考虑。
审查目的:三尖瓣反流是经三尖瓣起搏或植入式心律转复除颤器导联患者常见的瓣膜病变。经导管三尖瓣介入术越来越多地用于手术风险较高的患者。植入这些瓣膜可能会导致经三尖瓣导联被 "囚禁"。在无法进行传统经静脉导联取出术的情况下,这种做法存在导联失效和继发感染的短期和长期风险。在此,本手稿回顾了经导管三尖瓣介入患者导联管理的现有治疗方案:最近的研究结果:在某些高风险的病例中,决定植入导联可能是合适的,但在大多数病例中,拔除导联可能是更好的选择,因为再植入的选择多种多样,包括无导联起搏器、瓣膜保护系统、心外膜导联、直接通过人工瓣膜植入的导联以及完全皮下植入式除颤器。在美国,越来越多的患者符合植入 CIED 的要求。这些患者中有很大一部分会出现三尖瓣功能障碍,可能与经静脉导联有关,也可能与经静脉导联无关。与任何已显示出疗效的经皮介入治疗一样,随着这种疗法的发展超越了研究阶段,TTVI 的作用也可能会增加。因此,在未来几年中,心脏团队在这些患者的管理中将扮演越来越重要的角色,对于那些已有 CIED 导联的患者,我们主张心脏团队中应包括一名电生理学家。
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来源期刊
Current Cardiology Reports
Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.20
自引率
2.70%
发文量
209
期刊介绍: The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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