Utility of a Leadless Pacemaker as a Backup to Left Ventricle-only Pacing in a Patient with Prior Device-related Severe Tricuspid Regurgitation.

The contribution of endocardial cardiac device leads to severe tricuspid regurgitation (TR) has become increasingly recognized. Current strategies for treating cardiac device lead-related TR have limitations. We present a case of a pacemaker-dependent patient with severe TR as a complication of multiple cardiac device leads who underwent laser lead extraction, which was followed by implantation of a dual-chamber pacemaker with a coronary sinus lead for left ventricular pacing and a leadless transcatheter pacemaker for backup right ventricular (RV) pacing. This report represents one of the first cases of a leadless pacemaker implanted for RV backup pacing, highlighting the possibility of future biventricular pacing therapy (with a leadless pacemaker in VVT mode) without endocardial leads crossing the tricuspid valve.