Incidence, Predictors, and Management of Conduction Disturbances After Transcatheter Tricuspid Valve Replacement: The TRIPLACE Registry

Background: Transcatheter tricuspid valve replacement (TTVR) can induce high-grade atrioventricular block (HAVB), necessitating permanent pacemaker implantation (PPI). Limited data are available regarding this complication and management post-TTVR. Objectives: The aim of this study was to investigate the incidence, predictors, and management of conduction disturbances after TTVR. Methods: All consecutive patients undergoing TTVR in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were analyzed. The primary endpoint was the occurrence of HAVB at 1 month post-TTVR. Results: Of 263 TTVR patients, 75 (28.5%) were excluded because of pre-existing PPI and 3 (1.1%) because of surgical conversion. At 1 month, HAVB had occurred in 25 of the remaining 185 patients (13.5%), 88% within the first week post-TTVR (median 3.0 days; Q1-Q3: 2.0-5.0). New-onset right bundle branch block was observed in 20.6% of patients. Baseline left bundle branch block or left anterior or posterior fascicular block (adjusted OR: 3.63; 95% CI: 1.28-10.37; P = 0.016) was independently associated with HAVB, after adjusting for age and degree of device oversizing. PPI was performed using leadless technologies (45.5%), coronary sinus leads (27.3%), or transvalvular dual-chamber pacemakers (27.3%). Conclusions: HAVB occurred in 13.5% of PPI-naive patients who underwent TTVR. The majority of cases of HAVB (88%) were observed in the first week after TTVR. Baseline left bundle branch block or left anterior or posterior fascicular block confers a high risk for HAVB after TTVR. (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement [TRIPLACE]; NCT06033274)