Pacemaker Lead Jailed by the TricValve System: First Image Report

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00180. Epub July 15, 2024.

The emergence of new structural heart interventional procedures and techniques presents distinct challenges. One particularly noteworthy challenge involves the "jailing" of pacemaker leads by newly venous prostheses, a procedure that is not yet extensively documented in the medical literature. In this report, we provide a detailed 1-year follow-up of a patient with jailed pacemaker leads from transcatheter caval valve implantation (CAVI).

This is the case of a 60-year-old woman with a medical history of thoracic radiotherapy for Hodgkin's lymphoma and severe aortic stenosis due to radiation and degenerative disease associated with porcelain aorta. She was treated with a transcatheter aortic valve implantation 2 years earlier, and subsequently required a bicameral pacemaker implant. Follow-up revealed severe tricuspid regurgitation (previously degenerative and exacerbated by pacemaker lead interference), leading to persistent New York Heart Association Class III symptoms.

A transcatheter CAVI was performed. A 60-mm superior vena cava prosthesis encased the pacemaker leads upon their emergence from the left subclavian vein. Fluoroscopic imaging confirmed the entrapment of both pacemaker leads within the stent structure, a phenomenon known as "jailing" (Figure, Video). The initial post-deployment assessment showed normal lead function without dislodgment or significant impedance changes. The potential risks associated with lead jailing include lead fracture, insulation breach, and compromised sensing or pacing capabilities over time. At the 1-year follow-up, there was no variation in the lead impedance measurements.

This case is intended to highlight the importance of procedural caution when conducting superior vena cava valve implantation in patients with existing pacemaker leads. The monitoring of post-procedure pacemaker leads is essential to ensure long-term lead functionality and patient safety. The 1-year follow-up, with no pacemaker-related events, suggests that a pacemaker lead jailed by transcatheter CAVI is a safe strategy; however, more patients need to be studied.

Affiliations and Disclosures

Octavio Jiménez Melo, MD; Valeriano Ruiz-Quevedo, MD; Pablo Legarra Oroquieta, MD; Raúl Ramallal Martínez, MD; Oscar Alcalde Rodríguez, MD; Guillermo Sánchez Elvira, MD; Pablo Bazal Chacón, MD; David Conty Cardona, MD

From the Department of Cardiology, Hospital Universitario de Navarra, Pamplona, Spain.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement: The authors confirm that informed consent was obtained from the patient for the study and interventions described in the manuscript and to the publication thereof.

Address for correspondence: Octavio Jiménez Melo, MD, Hospital Universitario de Navarra, Irunlarrea Street 3, 31008 Pamplona, Navarra, Spain. Email: octavioj2000@gmail.com; X: @Octavio_JiMelo