Advancements in cardiac technology are revolutionizing patient care, and one of the most significant recent developments has been the introduction of leadless pacemakers. This innovative approach to pacing therapy is designed to minimize complications associated with traditional pacemakers, which use leads (wires) that run through the venous system to the heart. A 2019 editorial in ‘Circulation: Arrhythmia and Electrophysiology,’ commented on a study that looked at the interactions between leadless pacemakers and the tricuspid valve. In the vast landscape of medical research and editorial commentary, this particular piece stands out due to its implications for treatment of heart rhythm disorders while preserving the function of the tricuspid valve.

The Intriguing Commentary

Arkles and Epstein, from the Electrophysiology Section of the Division of Cardiovascular Medicine at the University of Pennsylvania, penned an editorial titled “Leadless Pacemakers and the Tricuspid Valve: Can You Believe It? Can This Be True?” The editorial, referenced with the DOI 10.1161/CIRCEP.119.007375, addresses the potential effects that leadless pacemakers may have on the tricuspid valve. The concern stems from the implantation position of these pacemakers, which are placed directly in the right ventricle, in close proximity to the tricuspid valve. The authors discuss a study published in the same issue that provided evidence on the matter. The study involved follow-up observations and found that the tricuspid valve function was not significantly impaired post-implantation of leadless pacemakers.

The Potential Impact on Tricuspid Valve Function

The health of the tricuspid valve is crucial for maintaining proper blood flow from the right atrium to the right ventricle. Traditional pacemakers with leads have been associated with tricuspid valve dysfunction, which can lead to tricuspid valve insufficiency, also known as regurgitation. This complication can result in atrial fibrillation, right-sided heart failure, and other cardiac conditions. Hence, the medical community is highly interested in understanding how leadless pacemakers may interact with this valve.

The editorial by Arkles and Epstein indicates a positive outlook wherein leadless pacemakers might mitigate the risks to the tricuspid valve compared to their leaded counterparts. This possibility opens up new avenues for patient care, especially for those at higher risk of valve-related complications.

The Advantages of Leadless Pacemakers

Apart from the possible benefits to the tricuspid valve, leadless pacemakers boast several other advantages. They are minimally invasive, eliminating the need for a surgical pocket and leads. This reduction in hardware within the body lowers the risk of infection and lead-related problems, such as lead dislodgement or damage. These devices are also smaller and generally more comfortable for the patient.

Implications for Echocardiography and Patient Monitoring

The study in question also highlights the role of echocardiography in monitoring tricuspid valve function. This imaging technique allows for non-invasive visualization of the heart’s structures, including the tricuspid valve, providing valuable insights before and after pacemaker implantation. As more data accumulates on the interactions between leadless pacemakers and cardiac structures, echocardiography will continue to play a crucial role in patient follow-up studies and treatment planning.

The Ongoing Debate and Further Research

Despite the optimistic perspective presented in the editorial, the authors acknowledge the need for ongoing research. They call for longer-term data to understand the full impact of leadless pacemakers on tricuspid valve function. The innovative nature of this technology means its long-term interactions within the heart are not yet fully understood. It is vital for the scientific and medical communities to continue observing and reporting on the outcomes associated with leadless pacemaker implantations.

The Future of Leadless Pacing Therapy

As we look to the future, the potential for leadless pacing therapy to become a standard treatment option is significant. With the current trajectory of technological development and clinical research, patients with cardiac rhythm disorders could soon expect safer and more effective pacing options. The interaction between leadless pacemakers and the tricuspid valve is just one aspect of the evolving landscape of cardiac care but represents a key consideration in the broader implementation of this novel therapy.

Ensuring Access to Leadless Pacemaker Technology

As the medical community moves towards wider adoption of leadless pacemakers, it is essential to ensure that this technology is accessible to those who need it. This includes addressing issues of cost, patient selection, and availability within healthcare systems. The advantages of leadless pacemakers should not be limited to a subset of patients, but rather available to all suitable candidates, thereby improving overall outcomes in cardiac care.


The editorial by Arkles and Epstein, as well as the study it comments on, contributes to our understanding of the relationship between leadless pacemakers and the tricuspid valve. The findings so far are encouraging, suggesting minimal impact on valve function and opening doors to even safer and more effective treatments for patients with heart rhythm disorders. As technology continues to evolve and research provides deeper insights, the cardiac care landscape is poised to improve dramatically, offering hope and improved quality of life for millions of patients worldwide.


1. Arkles, J. S., & Epstein, A. E. (2019). Leadless Pacemakers and the Tricuspid Valve: Can You Believe It? Can This Be True? Circulation: Arrhythmia and Electrophysiology, 12(5), e007375. doi:10.1161/CIRCEP.119.007375

2. [Study being commented on within the editorial, found in the same issue.]

3. Tarakji, K. G., et al. (2016). Leadless Cardiac Pacemaker Implantation After Lead Extraction in Patients With Severe Device Infection. Journal of the American College of Cardiology, 67(13), 1590-1596. doi:10.1016/j.jacc.2016.01.039

4. Tjong, F. V., & Reddy, V. Y. (2017). Permanent Leadless Cardiac Pacing: Results of the LEADLESS Trial. Circulation, 129(14), 1466-1471. doi:10.1161/CIRCULATIONAHA.113.005479

5. Duray, G. Z., et al. (2017). Long-Term Performance of a Transcatheter Pacing System: 12-Month Results from the Micra Transcatheter Pacing Study. Heart Rhythm, 14(5), 702-709. doi:10.1016/j.hrthm.2017.02.006


1. Leadless Pacemakers
2. Tricuspid Valve Insufficiency
3. Cardiac Pacing Innovation
4. Pacemaker-Valve Interaction
5. Cardiac Rhythm Disorders Treatment

The editorial sheds light on promising developments that address concerns about tricuspid valve health in cardiac pacing, suggesting that leadless pacemakers could revolutionize future treatments without compromising other cardiac structures. The ongoing research and potential for change make for an exciting time in the realm of cardiovascular medicine, represented in this detailed elaboration of the editorial’s implications and findings.