{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:01:40Z","timestamp":1785175300134,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tricuspid regurgitation (TR) is a recognized complication of cardiac implantable electronic devices (CIEDs), driven by both mechanical lead interference and pacing\u2010induced dyssynchrony. Leadless pacemakers eliminate transvalvular leads; however, the role of atrioventricular (AV) synchrony in mitigating TR progression remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review was informed by a structured literature search of PubMed, EMBASE, and the Cochrane Library through June 2025 using the search terms \u201cleadless pacemaker,\u201d \u201cMicra,\u201d \u201ctricuspid regurgitation,\u201d \u201catrioventricular synchrony,\u201d and \u201cconduction system pacing.\u201d Original studies, systematic reviews, and major guideline or review articles relevant to leadless pacing and TR were considered. Articles were selected based on relevance to the review objectives rather than predefined systematic review criteria. Formal risk\u2010of\u2010bias assessment or quality appraisal was not performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Leadless pacemakers generally demonstrate neutral effects on TR severity compared with baseline, although worsening of TR has been reported in approximately 9%\u201333% of patients across observational studies. Available evidence suggests that loss of AV synchrony is associated with TR progression independent of device type; however, pacing\u2010associated TR is multifactorial and likely also reflects ventricular dyssynchrony, right ventricular pacing burden, papillary muscle discoordination, right ventricular dysfunction, and progressive right\u2010heart remodeling. Direct comparative data evaluating Micra AV versus Micra VR with respect to TR outcomes remain unavailable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AV synchrony is biologically plausible for mitigating TR progression, but direct comparative evidence between Micra AV and Micra VR is lacking. Emerging dual\u2010chamber leadless systems may improve preservation of AV synchrony while maintaining the advantages of leadless pacing, although their long\u2010term effects on TR remain to be established. Prospective studies incorporating standardized echocardiographic endpoints are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70413","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:05:21Z","timestamp":1784199921000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tricuspid Regurgitation After Leadless Pacemaker Implantation: The Role of Atrioventricular Synchrony"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3273-7208","authenticated-orcid":false,"given":"Zachary Alvis","family":"Seal","sequence":"first","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debanshu","family":"Roy","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Alejandro Irizarry","family":"Caro","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan Alfredo Mijares","family":"Rojas","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamah Basil Ibrahim","family":"Altaee","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binish","family":"Qureshi","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam","family":"Nguyen","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0195-5063","authenticated-orcid":false,"given":"Robert","family":"Chilton","sequence":"additional","affiliation":[{"name":"UT Health San Antonio San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.02.037"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-304673"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.12.038"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.118.007124"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15565"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2019.10.017"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.14862"},{"issue":"7","key":"e_1_2_10_9_1","article-title":"Evolution and Prognosis of Tricuspid and Mitral Regurgitation Following Cardiac Implantable Electronic Devices: A Systematic Review and Meta\u2010Analysis","volume":"26","author":"Yuyun M. 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F.","year":"2024","journal-title":"Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.06.008"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.70087"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.05.022"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2216709"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.02.045"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2300080"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.2621"},{"issue":"5","key":"e_1_2_10_20_1","article-title":"Management of Patients With Transvalvular Right Ventricular Leads Undergoing Transcatheter Tricuspid Valve Interventions","volume":"27","author":"Deharo J. 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