Association of late tricuspid regurgitation progression and intracardiac lead types in patients after primary implantation of cardiac electronic devices

Abstract

Aim. To evaluate the factors and degree of progression of tricuspid regurgitation (TR) depending on the type of implanted electrode in patients after primary implantation of a cardiac implantable electronic device (CIED) in the late postoperative period.Methods. Case histories of 674 patients who underwent primary implantation of an implantable cardioverterdefibrillator (ICD) for the secondary prevention of sudden cardiac death for the period from 2009 to 2019 were analyzed and 75 case histories were selected. Using similar criteria, a comparison group was selected, who were implanted with a permanent pacemaker (PM) for sinus node dysfunction. For maximum comparability of the main and reference groups, pseudo-randomization was used using the nearest neighbor search method; 68 pairs were formed, comparable in terms of the main factors. Multiple logistic regression was used to analyze the predictors of progression of TR in the postoperative period.Results. In the preoperative period in the ICD group, 34 patients (50%) had a mild degree of TR, moderate and severe TR occurred in an equal number of cases 2 patients (2.9%) each. In the PM group, mild TR was detected in 24 cases (35.3%), moderate in 2.9% (n=2) of cases, respectively. In the postoperative period, predominantly mild TR was determined in both groups (in the ICD group in 67.6% (n=46), in the PM group in 48 patients (70.6%)).In the analysis of the general group of patients with implanted CIEDs (n=136), in the late postoperative period, an increase in the volume of both atria and the degree of TR was revealed. Left ventricular ejection fraction and end-diastolic volume didn’t have significant dynamics. All echocardiographic data obtained in the postoperative period were within the normal range.According to the results of multiple logistic regression, a history of coronary heart disease (CHD) has the greatest predictive power (hazard ratio 4.170; 95% confidence interval 1.751-9.933, p=0.001).Conclusion. TR in patients after primary implantation of a CIED in the late postoperative period progresses slightly, regardless of the type of right ventricular electrode. A long history of CHD is associated with the greatest risk of progression to tricuspid valve insufficiency.