Incidence and predictors of moderate to severe tricuspid regurgitation after dual‐chamber pacemaker implantation

Abstract

Introduction The incidence and predictors of tricuspid regurgitation (TR) after permanent pacemaker (PM) implantations have not been well evaluated. We attempted to determine TR's natural course and predictors, especially focusing on the influence of atrial fibrillation (AF). Methods Data from 530 patients with dual‐chamber PMs were evaluated. The main study outcomes were moderate to severe TR and isolated TR (moderate to severe TR without other structural heart diseases [SHDs]) in follow‐up echocardiography. Results Over a median follow‐up period of 7.6 years, moderate to severe TR developed in 14.5% patients. Of those, concomitant SHD was observed in 51.9% of patients, and 48.1% presented with isolated TR. A multivariable analysis identified the independent predictors of moderate to severe TR (diabetes mellitus [DM], chronic lung disease, preexisting mild TR, peripheral artery disease, moderate to severe aortic regurgitation, and persistent AF [PeAF]) and isolated TR (DM, preexisting mild TR, and PeAF). PeAF (n = 67, 12.6%) was an independent predictor of both moderate to severe TR (hazard ratio [HR] 2.59, 95% confidence interval [CI]: 1.22–5.51) and isolated TR (HR 4.54, 95% CI: 1.60–12.90). The patients with PeAF exhibited a higher incidence of moderate to severe TR (21.8% vs 12.9% vs 11.6% PeAF, paroxysmal AF, and without AF, respectively) and isolated TR (18.6% vs 6.6% vs 4.2%, respectively) during the follow‐up. Conclusion Moderate to severe TR after PM implantations developed with or without the influence of concomitant SHD. Patients with PeAF exhibited a higher risk of moderate to severe TR after PM implantations.

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

“…Atrial fibrillation was found to represent a risk factor for CIED-associated progression of TR [ 17 , 29 ]. In our univariate regression for progression of TR, atrial fibrillation and single ventricular pacing lead was found to be significantly associated with progression of TR.…”

Long-Term Follow-Up of Mortality and Heart Failure Hospitalisation in Patients With Intracardiac Device-Related Tricuspid Regurgitation

“…B: Landmark analysis of hospitalisations for heart failure in patients with followup beyond 12 months in patients with device-related TR vs patients without device-related TR. atrial fibrillation [19]. It is difficult to remove confounding from the assessment of the cause of TR as these associated comorbidities are likely contributors to the development of this complication.…”

The prognostic value of transesophageal echocardiography after transvenous lead extraction: landscape after battle

“…Another important issue addressed in the present study is tricuspid regurgitation induced by a right ventricular lead. LDTD is a well-known complication of CIED implantation occurring at a rate of 25% to 35% (21)(22)(23)(24)(25)(26), not infrequently being a direct indication for TLE (25)(26)(27). LDTD contributes to RA and RV enlargement and increases pulmonary arterial pressure, and what is important, it is associated with higher mortality in patients having CIED.…”

“…LDTD contributes to RA and RV enlargement and increases pulmonary arterial pressure, and what is important, it is associated with higher mortality in patients having CIED. Significant TR associated with the presence of right ventricular leads worsens long-term prognosis and is an independent risk factor for premature death (22)(23)(24). On the other hand, timely removal of the lead inducing valve dysfunction may result in valve improvement (Figure 3).…”