Induction and aggravation of atrioventricular valve regurgitation in the course of chronic right ventricular apical pacing

Alizadeh, Abolfath; Sanati, Hamid Reza; Hajikarimi, Majid; Yazdi, Ali Ghadami; Rad, Mohammad Assadian; Haghjoo, Majid; Emkanjoo, Zahra

doi:10.1093/europace/eur198

Cited by 60 publications

(29 citation statements)

References 18 publications

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“…Several other studies have also assessed TR before and after device implantation using echocardiography. 4,5,8,11,31 However, only one of those studies 8 evaluated the TV after lead implantation using 3D imaging. Previous studies using 2D imaging were unable to define mechanisms associated with increased TR post device lead placement and were therefore unable to separate TR secondary to lead interference from other causes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

Addetia

Maffessanti

Mediratta

et al. 2014

Journal of the American Society of Echocardiography

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Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR. Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis. Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively. Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.

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Section: Discussionmentioning

confidence: 99%

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

Addetia

Maffessanti

Mediratta

et al. 2014

Journal of the American Society of Echocardiography

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“…Post-MitraClip hemodynamics confirmed dramatic improvement in left atrial pressures throughout both paced and native rhythms ( Figure 5, Table 1). Transthoracic echocardiography on postoperative day 1 showed a mild decrease in left ventricular size and modest drop in left ventricular ejection fraction from 60-65% to 45-50% but with sustained mild residual MR. clinical scenarios ranging from acute severe MR immediately following pacemaker implantation to slow progression of MR in the setting of chronic right ventricular apical pacing [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

Bratincsák¹,

Rhee²,

Nguyen³

et al. 2017

jshd

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A 67-year-old male with Ebstein's anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient's permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.

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“…Patients who require pacemakers or internal cardiac defibrillators commonly have a permanent lead placed across the tricuspid valve (TV) into the right ventricle. However, multiple studies have shown development of TV dysfunction due to leads traversing the TV with up to 24% of patients developing worsening of TR by 1 grade and up to 5.3 % developing severe tricuspid regurgitation (TR) . Mechanisms of this lead‐induced TR include physical damage to the TV apparatus as well as reaction of tissue to the lead …”

Section: Introductionmentioning

confidence: 99%

Bioprosthetic tricuspid valve dysfunction in patients with transvalvular or epicardial pacing leads

Shafquat

Salahuddin

Aldawood

et al. 2018

Pacing Clinical Electrophis

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Induction and aggravation of atrioventricular valve regurgitation in the course of chronic right ventricular apical pacing

Cited by 60 publications

References 18 publications

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

Bioprosthetic tricuspid valve dysfunction in patients with transvalvular or epicardial pacing leads

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