Implantable cardiac devices, including defibrillators and pacemakers, may be the cause of tricuspid regurgitation (TR) or may worsen existing TR. Diagnosis by clinical exam and 2-dimensional echocardiography may be augmented by 3-dimensional echocardiography and/or computed tomography or cardiac magnetic resonance. The mechanism may be mechanical perforation or laceration of leaflets, scarring and restriction of leaflets, or asynchronized activation of the right ventricle. Pacemaker-related TR might cause severe right-sided heart failure. Percutaneous removal of PM and ICD leads is often performed in large specialty centers with significant experience, but carries with it significant and sometimes fatal risk. TR is usually treated by either surgical repair (usually consisting of ring annuloplasty) or by tricuspid replacement in some patients with advanced valvular disease