Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker: A single center experience, systematic review, and meta‐analysis

Abstract

Introduction: Conventional transvenous pacemaker leads may interfere with the tricuspid valve leaflets, tendinous chords, and papillary muscles, resulting in significant tricuspid valve regurgitation (TR). Leadless pacemakers (LLPMs) theoretically cause less mechanical interference with the tricuspid valve apparatus.However, data on TR after LLPM implantation are sparse and conflicting. Our goal was to investigate the prevalence of significant TR before and after LLPM implantation.Methods: Patients who received a leadless LLPM (Micra™ TPS, Medtronic) between May 2016 and May 2021 at our center were included in this observational study if they had at least a pre-and postinterventional echocardiogram (TTE). The evolution of TR severity was assessed. Following a systematic literature review on TR evolution after implantation of a LLPM, data were pooled in a random-effects meta-analysis. Results:We included 69 patients (median age 78 years [interquartile range (IQR) 72-84 years], 26% women). Follow-up duration between baseline and follow-up TTE was 11.4 months (IQR 3.5-20.1 months). At follow-up, overall TR severity was not different compared to baseline (p = .49). Six patients (9%) had new significant TR during follow-up after LLPM implantation, whereas TR severity improved in seven patients (10%). In the systematic review, we identified seven additional articles that

Characteristics and Incidence of Patients With Tricuspid Valve Prolapse After Micra Transcatheter Pacing System Implantation

“…9 On the other hand, worsening TR in the acute phase after LP implantation has rarely been reported in prior clinical trials. Haeberlin et al 3 reported that the majority of patients did not show a significant change in TV function after LP implantation, and the number of required LP deployments did not predict an increased incidence of TR in their analysis. In this way, the mechanism of worsening TR after LP implantation is still debatable.…”

“…1,2 By contrast, one meta-analysis showed no evidence of an increase in the prevalence of significant TR up to 1 year after leadless pacemaker implantation. 3 However, several centers have experienced a few cases of TV prolapse due to chordae tendineae rupture and worsening of TR after Micra TPS implantation. 4,5,6 The clinical characteristics of patient groups with TV prolapse caused by Micra TPS implantation are unknown.…”

Lead-related tricuspid regurgitation and ventricle dysfunction: Current management and future perspectives

“…53 Other solutions may involve a subcutaneous ICD or a leadless pacemaker; however, in the latter case, TR secondary to RV dysfunction associated with nonphysiological distribution of electric pulses or procedural complications can also occur. [63][64][65] A leadless pacemaker may also be used in combination with an sICD, or a lead can be implanted into the coronary sinus for biventricular pacing. 66 Some reports have shown good results with pericardial, extrapleural and substernal placement of defibrillator coils, separately or in conjunction with epicardial pacing leads, although their implantation requires employing surgical techniques.…”

Association of leadless pacing with ventricular and valvular function

“…The observed worsening of TR by any degree in 28% of patients is within the range reported in other leadless pacemaker cohorts: 4.3%-43%. [6][7][8][9] There are several potential explanations for the wide reported range. First, some studies have included individuals receiving both the Nanostim and Micra devices, including the study with the highest incidence of progressive TR.…”

“…6 Previous studies have produced conflicting evidence regarding the impact of leadless pacemakers on right ventricular and TV function. [6][7][8][9] In this study, we sought to describe the association of leadless pacing with valvular, right ventricular (RV) and left ventricular (LV) function by comparing pre-implant and post-implant echocardiographic measurements during extended follow up.…”