CIED-Related Tricuspid Regurgitation Managed With Lead Extraction, Leadless Pacing, and Annuloplasty.

BackgroundManagement of cardiac implantable electronic device-related tricuspid regurgitation remains challenging, particularly when lead interference coexists with annular dilation.Case summaryA 69-year-old woman with a single-chamber pacemaker presented with symptomatic severe lead-related tricuspid regurgitation. Echocardiography demonstrated septal leaflet impingement by the pacing lead and marked annular dilation. Because isolated lead extraction was unlikely to restore valve competence, transvenous lead extraction, leadless pacemaker implantation, and transcatheter tricuspid annuloplasty were performed. At 3-month follow-up, tricuspid regurgitation had decreased to a mild-to-moderate level, with improvement in heart failure symptoms.DiscussionThis case illustrates a feasible multimodality strategy for selected patients with cardiac implantable electronic device-related tricuspid regurgitation. Combining lead extraction, leadless pacing, and transcatheter annuloplasty may relieve mechanical leaflet interference, avoid renewed transvalvular lead disruption, and reduce annular dilation.Take-home messagesCompared with conventional transvalvular leads, leadless pacing causes less interference with tricuspid valve motion and may therefore reduce lead-related regurgitation. A combined approach involving lead extraction, leadless pacing, and transcatheter tricuspid annuloplasty can provide a practical therapeutic pathway for cardiac implantable electronic device-related tricuspid regurgitation.