Right Ventricular and Tricuspid Valve Function in Patients With Two Ventricular Pacemaker Leads

Abstract

SUMMARYExisting data on the effect of retained pacemaker leads on right ventricular (RV) and tricuspid valve function is limited.Objective: In this echocardiographic study we investigated the long-term effect of retained ventricular leads on RV and tricuspid valve function in patients with permanent pacemakers.Forty patients, 18 with two (group I) and 22 with one (group II) ventricular lead were assessed echocardiographically at an average of 39 months after the second lead implantation in group I and 80 months after the lead implantation in group II.The sum of the lead body diameter in group I was significantly greater than the body diameter in group II (P < 0.000). There was no significant difference between the groups with respect to chamber diameters and ventricular or valvular functions. The distributions of the different tricuspid regurgitation (TR) grades were similar, with the majority of patients in both groups having mild TR.Retained second pacemaker leads do not have an additional negative effect on right ventricular and tricuspid valve function. (Jpn Heart J 2004; 45: 103-108) Key words: Permanent pacemaker, Tricuspid regurgitation, Echocardiography, Retained leads LEAD dysfunction is one of the major problems/complications of permanent pacemaker therapy. Dysfunction due to mechanical or infective problems or electrical failure leads to replacement. Although lead extraction is done effectively and safely using the new extraction devices in many centers, there still exists a serious complication risk if it is done by inexperienced operators.1,2) Some of the functionless leads can not be removed safely and are left in situ if an absolute indication for extraction does not exist. It has been shown that the retained functionless pacemaker leads in the cardiovascular system are well tolerated unless they are infected and carry a very low complication rate. 3,4) Other possible comFrom the

Tricuspid Regurgitation and Implantable Devices

“…We did not find a difference in TR grade related to the number of leads implanted, and the published data in this regard are also controversial. Among 40 patients, Celiker et al found no difference in the degree of TR whether one or two leads were implanted, though the study was limited by a lack of preimplantation echocardiograms . On the other hand, Postaci et al found that more patients with two leads had grade 3+ TR (55.6%) compared with those patients with only one lead (55.6 vs 9.4%, P , 0.05) …”

Tricuspid Regurgitation in Patients With Pacemakers and Implantable Cardiac Defibrillators: A Comprehensive Review

“…However, 1 of the main limitations of the study is the absence of echocardiographic assessment of the tricuspid valve prior to lead implantation. 14 On the other hand, Postaci and colleagues found that patients with 2 device leads have more grade 3 TR, present in 55.6% of patients with 2 ventricular leads, compared to 9.4% in those with 1 lead (P < 0.05). 15 In the pediatric population, it was found that a risk factor for lead-related TR was congenital heart disease that is not right sided.…”

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

“…15 However, other studies have not found a significant relationship between number of leads and TR. 8,31 Therefore, while some studies have shown worse TR associated with multiple leads crossing the tricuspid annulus, this has not been universally demonstrated and does not seem to have adverse clinical or hemodynamic consequences.…”