Prophylactic Epicardial Pacemaker Implantation in Tricuspid Valve Replacement

Surgical tricuspid valve replacement (TVR) is associated with a high risk of postoperative atrioventricular (AV) block. However, placing pacemaker leads through a tricuspid bioprosthesis is discouraged since it might impair bioprosthesis function. Hence, alternative pacing approaches should be considered according to current cardiac pacing guidelines. 

This single center retrospective study assessed the benefits and risks of prophylactic epicardial pacemaker implantation during TVR. A total of eighty patients, with a mean age of fifty-seven years, who underwent TVR with concomitant prophylactic epicardial pacemaker implantation were analyzed. TVR was isolated in 28, or 35 percent of patients, but patients with other concomitant procedures were also included. During the postoperative period, with a mean follow-up period of thirty-five months, heart rhythm was analyzed in fifty-nine out of eighty patients. Cardiac pacing was needed in twenty-seven out of fifty-nine, or 46 percent of patients. Eight, or 14 percent, of patients had complete pacing dependency; ten, or 17 percent, of patients had a high degree AV block; nine, or 15 percent, of patients had a high ventricular pacing rate of over 80 percent. A postoperative spontaneous heart rate of over 70 bpm (P = 0.02) and the presence of a narrow QRS-complex (P = 0.03) were identified as predictors of lower cardiac pacing requirement. Epicardial pacemaker implantation was safe, with related complications observed in two, or 2.5 percent of patients. 

Given the frequent occurrence of AV block following TVR and the acceptable safety profile, the authors concluded that the prophylactic epicardial pacing strategy in patients undergoing TVR should be considered. The results from this study provide additional information to discuss the need for prophylactic epicardial pacing in patients undergoing tricuspid valve surgery.