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

Abstract

Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.

Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation

“…In the present study, we also demonstrated a significant reduction of PASP with HBP and a consequent amelioration of TR severity classification after HBP. Previous studies linked the worsening of TR with RV lead implantation positioned across the tricuspid valve 30–33 . In these studies, a decline in TAPSE and S wave velocity due to RVP was mainly responsible for the worsening of TR; we confirm a significant deterioration in longitudinal systolic function in our RVP group while we found preserved TAPSE and S wave velocity between baseline and follow up in the HBP group 30–33 .…”

Echocardiographic findings in patients with cardiac implantable electronic devices—analysis of factors predisposing to lead‐associated changes

“…In the initial phase after implantation, there is local deposition of blood platelets and fibrin on the surface of the lead. Then fibrous capsule is formed and the process mimicking scarring begins (Candinas et al, 1999; Dundar et al, 2011; Esposito et al, 2002; Kołodzińska et al, 2012; Trankle et al,2018). Lead endothelialization is characterized by varying intensity and progresses at its own pace in individual patients, additionally the fibrous reaction varies depending on the course of the lead.…”

“…In the present study, 23.5% of patients were found to have significant tricuspid regurgitation (grade III and IV), whereas significant lead‐related tricuspid dysfunction was confirmed in 6.2% of patients. In the available studies, the incidence of LDTD was estimated to range from 10% to 39% (Al‐Bawardy et al, 2015; Chang et al, 2017; Höke et al, 2014; Polewczyk et al, 2013; Trankle et al, 2018). Such discrepancies may result from difficulties in imaging the mechanism of tricuspid regurgitation.…”

The effect of active right ventricular pacing on tricuspid regurgitation grade and right ventricular contractility in patients with sick sinus syndrome regardless of the mechanical interference to the valve by the electrode

“…В дальнейшем эти явления могут привести к функциональным нарушениям клапана и правых камер сердца. При этом клинические проявления могут демонстрировать широкий спектр тяжести состояния пациента, а также весьма вариабельный временной интервал между имплантацией и ухудшением гемодинамики [20].…”