Tricuspid Regurgitation and Leadless Pacemakers: A State-of-the-Art Review.

Abstract

Tricuspid regurgitation (TR) is increasingly recognized as a major contributor to cardiovascular morbidity and mortality, with growing attention to its development and progression in patients with cardiac implantable electronic devices (CIEDs). While leadless pacemakers (LPMs) were introduced to eliminate transvalvular leads-long considered the primary driver of CIED-related TR-emerging evidence suggests that LPMs do not completely eliminate the risk of developing new or worsening TR. Instead, TR in this population appears to arise from a broader set of mechanical, anatomical, and electrophysiologic mechanisms, many of which extend beyond the historical lead-impingement paradigm. This review consolidates the current knowledge on epidemiology, mechanisms, and diagnostic challenges, while outlining a multidisciplinary framework for diagnosis and management strategies of LPM-related TR. In addition, we aim to highlight current gaps in evidence and areas for future investigation.