Abstract
Leadless pacemakers have become an effective alternative to conventional transvenous pacemakers to prevent the risk of lead failure, pocket complications, and iatrogenic tricuspid regurgitation. The current transcatheter approach for tricuspid valve repair can limit the implantation of these devices, unless the procedure is performed with appropriate image guidance. We present the case of a patient with severe tricuspid regurgitation secondary to pacemaker lead impingement who, despite the implantation of a tricuspid clip, received a leadless pacemaker. The procedure was successfully guided by transthoracic echocardiography, an alternative to transesophageal or intracardiac echocardiography.