3D Echocardiographic Location of Implantable Device Leads and Mechanism of Associated Tricuspid Regurgitation

Mediratta, Anuj; Addetia, Karima; Yamat, Megan; Moss, Joshua D.; Nayak, Hemal M.; Burke, Martin C.; Weinert, Lynn; Maffessanti, Francesco; Jeevanandam, Valluvan; Mor‐Avi, Victor; Lang, Roberto M.

doi:10.1016/j.jcmg.2013.11.007

Cited by 106 publications

(122 citation statements)

References 35 publications

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“…28 However, lead location has not been shown to affect tricuspid regurgitation 29 but use of 3D echocardiography to evaluate the etiology of tricuspid regurgitation may be useful. 29,30 3D echocardiography may also aid in determining torque force of the patients ventricle, 31 unfortunately this sophisticated imaging was not performed. Furthermore, subcutaneous ICD (S-ICD) may eliminate the risk of tricuspid regurgitation associated with endovascular leads.…”

Section: Discussionmentioning

confidence: 99%

Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

et al. 2016

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“…In patients with implanted devices, reconstructed images were carefully reviewed to determine the position of the device-lead relative to the TV leaflets. 13 After the 3D TV screening and an in-depth chart review, FTR was categorized into the following 4 types: (1) FTR because of the leftsided heart disease (valve disease or left ventricular dysfunction), (2) FTR because of any cause of pulmonary arterial hypertension (chronic lung disease, pulmonary thromboembolism, left-to-right shunt disease, or Doppler estimated systolic pulmonary artery pressure of >50 mm Hg without an identifiable clinical cause), (3) FTR because of any cause of RV dysfunction (myocardial disease or RV ischemia/ infarction), and (4) FTR with no detectable cause of TR other than chronic AF.…”

Section: D Tv Screening and Ftr Subgroup Determinationmentioning

confidence: 99%

Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation

Utsunomiya

Itabashi

Mihara

et al. 2017

Circ: Cardiovascular Imaging

195

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Background— Functional tricuspid regurgitation (TR) with a structurally normal tricuspid valve (TV) may occur secondary to chronic atrial fibrillation (AF). However, the clinical and echocardiographic differences according to functional TR subtypes are unclear. Therefore, characterization of functional TR because of chronic AF (AF-TR) remains undetermined. Methods and Results— To investigate the prevalence of AF-TR, 437 patients with moderate to severe TR underwent 3-dimensional (3D) transesophageal echocardiography. TR severity was determined by the averaged vena contracta width on apical and parasternal inflow views. The prevalence of AF-TR was 9.2%, whereas that of functional TR because of left-sided heart disease was 45.3%. Clinical features of AF-TR included advanced age, female sex, greater right atrial than left atrial enlargement and lower systolic pulmonary artery pressure compared with left-sided heart disease-TR with sinus rhythm (all P <0.05). In 3D TV assessment, patients with AF-TR had a larger TV annular area with weaker annular contraction (both P <0.001) but a smaller tethering angle ( P <0.001) despite a similar leaflet coaptation status compared with patients with left-sided heart disease-TR with sinus rhythm. On multivariable analysis, only the TV annular area in midsystole (coefficient, 0.059; 95% confidence interval, 0.041–0.078 per 100 mm 2 ; P <0.001) was associated with TR severity in AF-TR. The annular area was more closely correlated with the right atrial volume than right ventricular end-systolic volume in AF-TR ( P <0.001). Conclusions— AF-TR is not rare and is associated with advanced age and right atrial enlargement. TV deformations and their association with right heart remodeling differ between AF-TR and left-sided heart disease-TR. Our results suggest that in patients with TR secondary to AF, TV annuloplasty should be effective because this entity has annular dilatation without leaflet deformation.

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“…We recently reported on an observational study 15 that described the use of three-dimensional (3D) echocardiography for the visualization of device leads as they traverse the TV. We found that TR was present when implanted device leads were interfering with the normal TV leaflet motion.…”

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confidence: 99%

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

Addetia

Maffessanti

Mediratta

et al. 2014

Journal of the American Society of Echocardiography

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Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR. Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis. Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively. Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.

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3D Echocardiographic Location of Implantable Device Leads and Mechanism of Associated Tricuspid Regurgitation

Abstract: 3D TTE showed a clear association between device lead position and TR. To minimize TR induced by device-leads, 3D TTE guidance should be considered for placement in a commissural position.

Cited by 106 publications

References 35 publications

Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy

Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

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