Tricuspid regurgitation associated with implantable electrical device insertion: A systematic review and meta‐analysis

Abstract

Background Implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) lead placement may worsen or result in tricuspid regurgitation (TR). While the association between lead placement and the incidence of TR has been established, current understanding of this problem remains incomplete. This systematic review and meta‐analysis sought to pool the existing evidence to better understand the occurrence and severity of TR associated with cardiac implantable electrical device (CIED) insertion. Methods An electronic search was performed to identify all relevant studies published from 2000 to 2018. Overall, 15 studies were selected for the analysis comprising 4019 patients with data reported on TR development following ICD or PPM lead placement. Demographic information, perioperative clinical variables, and clinical outcome measures, including pre and postoperative echocardiographic TR grade changes, were extracted and pooled for systematic review. Results Mean patient age was 69 years [95% CI: 64.62‐73.59], and 63% [95% CI: 57‐68] were male. Devices implanted included ICD in 57% [95%CI: 43‐70] and PPM in 41% [95%CI: 31‐52]. The most common indications for pacemaker implantation were sick sinus syndrome in 22% [95% CI: 22‐37] and AV block in 21% [95%CI:12‐34. The commonest indications for ICD implantation were primary and secondary prevention of sudden cardiac death. Atrial fibrillation was present in 37% [95%CI: 28‐46] and congestive heart failure in 15% [95%CI: 2‐57]. Baseline distribution of TR grades were as follows: grade 0/1 TR in 89% [95%CI: 82‐93], grade 2 TR in 8% [95%CI: 5‐13], grade 3 TR in 2% [95%CI: 0‐7] and grade 4 TR in 2% [95%CI: 1‐4]. Post‐procedure, grade 0/ 1 TR decreased to 68% [95% CI: 51‐81] (p < 0.01), grade 2 TR increased to 21% [15‐28] (p < 0.01), grade 3 TR increased to 13% [95%CI: 5‐32] (p = 0.02), and grade 4 TR increased to 7% [95%CI: 5‐9] (p < 0.01). Conclusion ICD and PPM lead placement is associated with increased TR post‐procedure. Further studies are warranted to evaluate changes in TR grade in the long term.

Tricuspid regurgitation in His bundle pacing: A systematic review

“…In the 1970s, postmortem investigations demonstrated that pacemaker leads can adhere to the TV leaflets or the papillary muscles (Gibson et al, 1980 ). In chronic TR, a number of studies have demonstrated that adhesion of TV leaflet to the pacing lead results in restricted movement, causing an abnormal coaptation of the posterior leaflet with the anterior and septal leaflets (Addetia et al, 2019 ; Tatum et al, 2021 ).…”

Association between cardiovascular implantable electronic devices and tricuspid regurgitation: a case-control study

“…[3] Meanwhile, the transvalvular lead of the ICD may generate additional weight and rigidity to the tricuspid valve due to its calibre. [10] Our findings revealed that preimplantation atrial fi brillation was involved in the presence of post-implantation TR. Some studies have reported that atrial fibrillation is associated with annular dilation and results in TR even in the absence of device leads.…”

Tricuspid valve disease and cardiac implantable electronic devices

“… 56 Tatum et al . 57 reported that lead placement is associated with post-procedural TR worsening in 20% of the patients with a total prevalence of at least moderate TR in 41%.…”