Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

Abstract

Background: Lead-dependent tricuspid dysfunction (LDTD) is one of important complications in patients with cardiac implantable electronic devices. However, this phenomenon is probably underestimated because of an improper interpretation of its clinical symptoms. The aim of this study was to identify LDTD mechanisms and management in patients referred I and II (91.7% vs. 94.2%; p = 0.6 and 100% vs. 98.4%; p = 0.46, respectively (Cardiol J 2013; 20, 4: 402-410)

Late resolution of pacemaker lead–related severe tricuspid regurgitation and right ventricular dysfunction after percutaneous lead extraction: A case report and review of the literature

“…It was proposed that tricuspid annular dilatation, which was present in all cases, may be both a marker and a mechanism for irreversible ELTR and therefore that surgical options may be required once it occurs. In contrast, Polewczyk et al 10 described improvement in TV function in 15 of 24 patients with lead-related TV dysfunction (20 with severe ELTR, 4 with coexisting tricuspid stenosis) treated with percutaneous lead extraction despite reimplantation of an RV lead in the majority of cases. “Marked clinical improvement” was noted in 75% of patients at a mean follow-up of 1.5 years, including improved exercise tolerance and peripheral edema.…”

“…In contrast, major complications occur in <0.8% of patients undergoing contemporary percutaneous lead removal at experienced centers 7 and in as little as 0% of cases involving leads less than 1 year old 8 . Nevertheless, the role of percutaneous interventions for ELTR remains unclear, with 3 reports suggesting unpredictable improvements in TR and RV function with this approach 9, 10, 11. We describe a patient with severe, symptomatic ELTR associated with RV dysfunction and tricuspid annular dilatation that resolved between 10 and 12 months after percutaneous ventricular lead extraction.…”

To Extract or Retain a Sterile, Nonfunctional Lead

“…21 Also, with multiple ventricular leads crossing the tricuspid valve, a higher risk of tricuspid valve dysfunction can ensue. 25 A higher burden of leads in the vasculature, as well as in the ICD pocket, also increases the chances of leads rubbing against each other or against the device, resulting in insulation defects, noise, and further lead failure. 26 Extract or Retain a Sterile, Nonfunctional Lead she would have 4 leads through her SVC.…”

Case report of a successful permanent pacing through the coronary sinus in a patient after tricuspid valve replacement

“…Орга-ническая патология трикуспидального клапана (ТК) часто приводит к необходимости выполне-ния пластики или протезирования, при котором проведение электрода через ТК не является ме-тодом предпочтения. При эндокардиальной им-плантации электрода для постоянной ЭКС че-рез ТК возможно развитие его дисфункции с выраженной регургитацией [4][5][6]. В литерату-ре описаны случаи успешной имплантации эн-докардиального электрода для стимуляции сердца через коронарный синус у пациентов с механическими клапанами в трикуспидальной позиции [7,8].…”