Clinical significance of increased tricuspid valve incompetence following implantation of ventricular leads

Abstract

Increased TR following CRMD implantation is relatively common (33%) and correlated with subsequent risk of hospitalization for heart failure. A preventive strategy and close monitoring for development or worsening of CHF after CRMD implantation may help prevent hospital admissions.

Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads

“…There are multiple retrospective and cross‐sectional series available, which find overall rates of TR higher in patients who have intracardiac leads compared to those without devices . In retrospective studies focusing only on patients who had available TTEs performed before and after device implant, the rates of new or increased severity of TR range between 9% and 38% . However, these analyses by design omit the patients who had no postimplantation TTE (presumably in part due to the clinical stability of those patients), and thus may be vulnerable to overestimation from selection bias.…”

“…Limited data involving leads which pass through bioprosthetic TVs or ring annuloplasties have not been shown to significantly increase rates of valvular dysfunction. Just as TR from any cause independently worsens survival, TR which develops or worsens after lead implantation has been associated with increased hospitalizations for heart failure and long‐term mortality …”

Micra Transcatheter Pacing System Implant under Direct Visualization During Minimally Invasive Tricuspid Valve Surgery

“…However, the mechanical interference between transvalvular leads and TV leaflet mobility and coaptation can result in regurgitation rendering such an approach counterintuitive [19]. The prevalence and incidence of significant TR following CIED implantation ranges from 10% to 39% with a higher risk attributable to implantable cardiac defibrillator (ICD) leads or presence of more than 1 RV lead [20][21][22][23][24][25][26][27]. The impact of pacing or defibrillation leads on the development of significant TR after TV repair or replacement has also been reported in observational retrospective studies with findings ranging from severe TR to no significant effect on the repaired TV function [28][29][30].…”

Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease

“…Endocardial leads crossing the TV can damage (through stenosis or regurgitation) [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] and be damaged by (through insulation abrasion [11] , [14] or conductor fracture [15] ) the valve, especially after surgical correction of severe pre-existent disease [16] . Tricuspid regurgitation is more common and severe in the presence of transvenous leads, and is then associated with increased mortality [17] , [18] , [19] .…”