Severe Tricuspid Regurgitation in a Patient With a Cardiac Implantable Electronic Device: What We Have Learned

Background: Cardiac implantable electronic devices (CIEDs) are associated with the occurrence of tricuspid regurgitation (TR) leading to poor outcomes. The distinction between CIED-induced TR and other etiologies is often challenging, making its optimal management difficult. Clinical Condition: We describe a case of CIED-induced TR, discuss its common diagnostic/managements challenges, and analyze recent definitions/classifications and position statements. Key Questions: What are the most common challenges in diagnosing CIED-induced TR? What are the different causative mechanisms of CIED-inducing TR? How can CIED-induced TR be classified? What are the different management strategies for CIED-induced TR, and what are the main factors to consider? Outcome: The patient underwent successful right ventricular lead extraction and placement of a right atrial lead and a coronary sinus lead. Repeat echocardiography showed reversed right ventricular remodeling with improvement of the TR.