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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Eleid MF. Generalizing Tricuspid Clinical Trial Results to the "Real World". JACC Cardiovasc Interv 2024; 17:549-551. [PMID: 38418057 DOI: 10.1016/j.jcin.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Mackram F Eleid
- Divisions of Interventional Cardiology and Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Dershowitz L, Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Vahl TP, Nazif T, Khalique O, Ng V, Kurlansky P, Leon M, Hahn R, Kodali S, George I. Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2024; 103:367-375. [PMID: 37890014 DOI: 10.1002/ccd.30850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/20/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
AIMS Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. METHODS We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention. RESULTS We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03). CONCLUSION Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention.
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Affiliation(s)
- Lyle Dershowitz
- Division of Internal Medicine, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew K Lawlor
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Martin Leon
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Rebecca Hahn
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
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Stocker TJ. Last, But Not Least: TricValve Implantation Reduces Heart Failure Burden in Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2024; 17:73-75. [PMID: 38069987 DOI: 10.1016/j.jcin.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Thomas J Stocker
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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Ho EC, Assafin M, Sugiura T, Granada JF, Chau M, Latib A. 3-dimensional intracardiac echocardiography for structural heart interventions. Front Cardiovasc Med 2023; 10:1180299. [PMID: 38045907 PMCID: PMC10690929 DOI: 10.3389/fcvm.2023.1180299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023] Open
Abstract
New generation 3-dimensional matrix array intracardiac echocardiography catheters have become commercially available recently, increasing image plane options compared to 2-dimensional and older generation 3-dimensional intracardiac echocardiography catheters. They are beginning to play an important role in structural heart interventions, especially for transcatheter tricuspid interventions, due to advantages in some situations that increase image quality over transesophageal echocardiography.
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Affiliation(s)
- Edwin C. Ho
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Manaf Assafin
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Juan F. Granada
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Cardiovascular Research Foundation, New York, NY, United States
| | - Mei Chau
- Division of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
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Ancona F, Mangieri A, Spartera M, Taramasso M. Editorial: Open issues in the diagnosis and management of tricuspid regurgitation. Front Cardiovasc Med 2023; 10:1189956. [PMID: 37139118 PMCID: PMC10150317 DOI: 10.3389/fcvm.2023.1189956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
- Correspondence: Francesco Ancona
| | | | - Marco Spartera
- Cardiothoracic Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, OCMR, Oxford, United Kingdom
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Switzerland and University of Zurich, Switzerland
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Romeo JD, Bashline MJ, Fowler JA, Kliner DE, Toma C, Smith AJC, Sultan I, Sanon S. Current Status of Transcatheter Tricuspid Valve Therapies. Heart Int 2022; 16:49-58. [PMID: 36275351 PMCID: PMC9524678 DOI: 10.17925/hi.2022.16.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2024] Open
Abstract
Tricuspid regurgitation is a complex disease that carries a poor prognosis, and surgical repair is associated with high mortality. In light of the success of other transcatheter-based valve interventions, transcatheter tricuspid therapy has recently seen exponential use both clinically and in innovation. Given the rapid development of many tricuspid systems and multiple on-going clinical trials, the aim of this review is to highlight the current state of transcatheter tricuspid therapeutics and to provide an up-to-date view of their clinical use, outcomes and future directions.
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Affiliation(s)
- Jared D Romeo
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael J Bashline
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Fowler
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - AJ Conrad Smith
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saurabh Sanon
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Dumonteil N. Transcatheter Treatment of Concomitant Aortic Stenosis and Tricuspid Regurgitation: Are We There Yet? JACC Cardiovasc Interv 2021; 14:2257-2259. [PMID: 34600875 DOI: 10.1016/j.jcin.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France.
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Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention: Coaptation Devices. Front Cardiovasc Med 2020; 7:139. [PMID: 32903754 PMCID: PMC7438895 DOI: 10.3389/fcvm.2020.00139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Transcatheter tricuspid valve intervention (TTVI) has recently emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). Multiple percutaneous devices have been developed in the last decade with promising early results. Among them, the coaptation devices are designed to reduce TR severity by valve leaflet plication or occupying the regurgitant orifice with a spacer. To date, the MitraClip/TriClip devices (Abbott, Santa Clara, CA, USA), the PASCAL system (Edwards Lifesciencies, Irvine, CA, USA), and the FORMA device (Edwards Lifesciencies, Irvine, CA, USA) have been used as coaptation devices for treating severe TR. The present document aimed to review the clinical evidence on coaptation devices in the field of TTVI, describing its design characteristics, main procedural steps, and early and mid-term outcomes.
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Affiliation(s)
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
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10
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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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