Tricuspid regurgitation in His bundle pacing: A systematic review

Abstract

Objective This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP). Methods A literature review was conducted using Mesh terms (His bundle pacing, tricuspid regurgitation, tricuspid valve incompetence, etc.) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library till October 2021. Relevant studies evaluating tricuspid regurgitation in HBP were included and information regarding TR and its related factors (ejection fraction (EF) and New York Heart Association (NYHA) class) were retrieved from the eligible studies. Results Out of 196 articles, 10 studies met the inclusion criteria, which consisted of 546 patients with HBP. The mean age of the patients ranged between 61.2 ± 12.3 and 75.1 ± 7.9 years with 54.1% males. The overall implant success rate was 79.2%. Only one study reported a 5% incidence of TR, while 9 studies reported no new TR after HBP. Four studies reported overall decrease in TR by 1 grade and 3 studies demonstrated increased TR from baseline. Two studies showed no change from baseline TR. Conclusion HBP causes improvement in TR grade after HBP for cardiac resynchronization therapy (CRT) as well as atrioventricular block (AVB). Further studies in the form of randomized controlled trials are required to further evaluate the effect of HBP on tricuspid valve functioning.

Analysis of tricuspid regurgitation improvement following cardiac resynchronization therapy

“…A 2022 systematic review by Zaidi et al . 3 found results that were comparable with those of Stassen et al for the use of His bundle pacing. Of the 10 studies considered in the review four studies showed an improvement in TR grade following HBP at 12–17 month follow-up.…”

“…Of the 10 studies considered in the review four studies showed an improvement in TR grade following HBP at 12–17 month follow-up. 3 Wu et al conducted a study comparing His bundle pacing in candidates for CRT and concurred with the results of Zaidi et al ., as they found baseline TR had reduced at 12 month follow-up. 4 …”

Cardiac implantable electronic device‐induced tricuspid regurgitation: Implications and management

“…However, in a meta-analysis of eight observational studies and two randomized clinical trials involving 546 patients who underwent His-bundle pacing, there were mixed outcomes with some studies reporting overall decrease in TR and other studies demonstrating increased TR from baseline. 50 Similarly, the concept was not supported in a comparison of 472 patients who received either left bundle branch area pacing or RV septal pacing with the same thin Medtronic 3830 lead (SelectSecure System, Medtronic, Inc.); the rate of worsening TR at 1 year (15.2% vs. 17.2%; p > .05) and 2 years (21.6% vs. 24.6%; p > .05) was similar between groups. 51 A shorter distance between the electrode fixation site to the tricuspid annulus was found to discriminate the risk of worsening TR, such that TR progression was highest in patients with leads <1.9 cm from the annulus.…”

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

“…Stimulation of the His bundle seems to be the most physiological technique and the least related to secondary TR evoked by pacing. 62 In some cases, epicardial leads are used. 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.…”