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.