Simultaneous Tricuspid Valve Replacement and Left Bundle Branch Area Pacing With Surgical Lead Refixation.
Kentaro Goto, Shinsuke Miyazaki, Ayaka Usui et al.
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Case in brief
A 58-year-old man with complete atrioventricular block developed severe left ventricular dysfunction after right ventricular apical pacing. Conventional cardiac resynchronization therapy produced only modest improvement, while lead-related tricuspid regurgitation progressed to biventricular heart failure and recurred after valve repair. The heart team proceeded with left bundle branch area pacing (LBBAP) and tricuspid valve replacement (TVR). The LBBAP lead was dislodged during surgery, but its insertion site was identified, and the lead was reinserted and secured outside the prosthetic valve. At three months, symptoms had markedly improved, LVEF was 50%, and lead parameters remained stable.
What made this case unusual
The LBBAP lead was implanted before TVR as an “electrophysiological anchor”; after it was dislodged during surgery, the surgeon located its insertion site and refixed it in a protective position outside the prosthetic valve.
Diagnostic / clinical pearl
When LBBAP and TVR are both needed, lead displacement during valve surgery may be managed by identifying the insertion site and refixing the lead, though prosthetic-valve lead jailing requires caution about long-term survival.