Tricuspid Valve Regurgitation Following Temporary or Permanent Endocardial Lead Insertion, and the Impact of Cardiac Resynchronization Therapy

Abstract

Background: While some studies indicate that permanent pacemaker implantation is associated with development of tricuspid regurgitation (TR), other studies indicate no association.Little is known about the impact of temporary lead insertion during ablation procedures, or whether therapy (CRT) prevents TR post-device implantation.Hypothesis: We hypothesized that permanent, but nottemporary endocardial leads, are associated with development of TR, and that CRT would prevent (physiologic) TR.Methods: We performed a retrospective study of consecutive patients who underwent first device or radiofrequency catheter ablation over a 12-month period at a single, tertiary academic center who underwent pre- and post-procedure echocardiography. Results: In the 89 patients in the device group, the degree of TR significantly increased ≥ 1 grade post-permanent lead implantation: 9 had less TR, 46 were unchanged, and 34 had more TR(p=0.005). TR increased in the 62 patients who underwent device implantation without CRT (p=0.005), but did not increase in the 27 patients with CRT (p=0.47). In the 66 patients in the ablation group, there was no significant change in TR post-ablation: 8 had less TR, 48 were unchanged, and 10 had more TR (p=0.31). Conclusion: Permanent endocardial lead implantation was associated with an increase in TR; however, patients who underwent device implantation with CRT did not have an increase in TR.Temporary lead insertion during ablation was not associated with changes in the degree of TR. A large, prospective study is needed to accurately define the incidence and exact mechanisms of permanent endocardial lead-related TR.

Prevalence and Clinical Predictors of Right Ventricular Dysfunction in Patients with Chronic Right Ventricular Pacing

“…Right Ventricular Dysfunction Many patients with permanent pacemaker have right side heart failure symptoms that leads to development of tricuspid regurgitation. 16,17 In contrast, RV dysfunction showed no significant correlation with presence of meaningful tricuspid regurgitation in this study. This suggests that chronic RV pacing could lead to right heart failure without clinically significant TR and associated RV dysfunction.…”

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

“…The authors suggest that chronic RV pacing might thus be responsible for increased TR through left heart deterioration and pulmonary venous congestion rather than direct alterations of the RV or TV . Cardiac resynchronization therapy (CRT) may, therefore, offer a solution to treat or avoid this phenomenon, and a small retrospective study demonstrated a lack of increased TR in a cohort of patients receiving CRT compared to worsened TR in patients receiving non‐CRT PPMs or ICDs . Selection criteria for preventative or secondary CRT implantation to avoid this phenomenon are unclear …”

Ventricular Pacing–Induced Tricuspid Regurgitation After Cardiopulmonary Bypass

“…[8][9][10] Even though pacing the left ventricle via a coronary sinus lead may be an option for the chronic management of patients with AV valve regurgitation secondary to right ventricular pacing, this is not a viable intraoperative management strategy. 6,11 Other than reverting to the patient's underlying rhythm, which resolved the issue in the previous case, intraoperative management options include reliance on the native conduction pathway via an atrial pacing mode, instituting atrial and ventricular pacing to optimize the AV interval, or changing the location of the epicardial lead. 12 If the previously described alterations to electrical activation do not correct new functional tricuspid regurgitation fully, an unnecessary procedure may be avoided by recognizing epicardial right ventricular pacing as a possible cause of new tricuspid regurgitation.…”