1887
Volume 2020, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Aim: The aim of this study was to evaluate the progression of tricuspid regurgitation (TR) in patients with pacemaker leads across the tricuspid valve and assess the clinical effect on right ventricular (RV) function.

Methods: Patients who had undergone permanent pacemaker implantation at our institution over an 8-year period were identified. Those who had an echo (for any indication) pre- and postdevice implantation were included in this study, and their data assessed. Clinical information was obtained from their medical records. A total of 65 patients (mean age 70 ± 13 years, 31 (48%) males, and 34 (52%) females) were enrolled in the study.

Results: The median interval of echo after implantation was 12 (12 to 24) months. Before implantation, 29 patients had TR, which increased to 51 (78%) during follow up, indicating that 22 patients developed new TR. Of those with preexisting TR, the grade of TR had worsened by at least one grade in 17 patients. RV function as measured by tricuspid annular plane systolic excursion (TAPSE) had decreased from 1.87 ± 0.44 to 1.68 ± 0.42 ( = 0.002). Eighteen patients had developed signs of right heart failure (either breathlessness with raised jugular venous pressure or pedal edema or both), of which 13 had only new pedal edema.

Conclusion: There is a definite progression of TR in patients with a pacing lead across the tricuspid valve (TV) associated with an increase in the incidence of right heart failure. Patients with a pacing lead across the TV should be followed closely for signs of right heart failure.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2020.40
2021-01-02
2021-04-10
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2020/3/qmj.2020.40.html?itemId=/content/journals/10.5339/qmj.2020.40&mimeType=html&fmt=ahah

References

  1. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures. J Am Coll Cardiol 2012 Oct 16;60(16):1540–5 .
  2. Paniagua D, Aldrich HR, Lieberman EH, Lamas GA, Agatston AS. Increased prevalence of significant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol 1998 Nov 1;82(9):1130–2 .
  3. Delling FN, Hassan ZK, Piatkowski G, Tsao CW, Rajabali A, Markson LJ, et al. Tricuspid regurgitation and mortality in patients with transvenous permanent pacemaker leads. Am J Cardiol 2016 Mar 15;117(6):988–92 .
  4. Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM. Cardiac implantable electronic device lead-induced tricuspid regurgitation. JACC Cardiovasc Imaging 2019 Apr;12(4):622–36 .
  5. Rothschild DP, Goldstein JA, Kerner N, Abbas AE, Patel M, Wong WS. Pacemaker-induced tricuspid regurgitation is uncommon immediately post-implantation. J Interv Card Electrophysiol 2017 Sep;49(3):281–7 .
  6. Wilner BR, Coffey JO, Mitrani R, Carrillo RG. Perforated tricuspid valve leaflet resulting from defibrillator leads: a review of the literature. J Card Surg 2014 Jul;29(4):470–2 .
  7. Moreno R, Zamorano J, Ortega A, Villate A, Almeria C, Herrera D, et al. Tricuspid valve chordae rupture following pacemaker electrode replacement. Int J Cardiol 2003 Feb;87(2-3):291–2 .
  8. Lee RC, Friedman SE, Kono AT, Greenberg ML, Palac RT. Tricuspid regurgitation following implantation of endocardial leads: incidence and predictors. Pacing Clin Electrophysiol 2015 Nov;38(11):1267–74 .
  9. Krupa W, Kozlowski D, Derejko P, Swiatecka G. Permanent cardiac pacing and its influence on tricuspid valve function. Folia Morphol (Warsz) 2001 Nov;60(4):249–57 .
  10. Vaturi M, Kusniec J, Shapira Y, Nevzorov R, Yedidya I, Weisenberg D, et al. Right ventricular pacing increases tricuspid regurgitation grade regardless of the mechanical interference to the valve by the electrode. Eur J Echocardiogr 2010 Jul;11(6):550–3 .
  11. Alizadeh A, Sanati HR, Haji-Karimi M, Yazdi AH, Rad MA, Haghjoo M, et al. Induction and aggravation of atrioventricular valve regurgitation in the course of chronic right ventricular apical pacing. Europace 2011 Nov;13(11):1587–90 .
  12. Saito M, Kaye G, Negishi K, Linker N, Gammage M, Kosmala W, et al. Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing. Heart 2015 Apr;101(8):600–8 .
  13. Saito M, Iannaccone A, Kaye G, Negishi K, Kosmala W, Marwick TH. Effect of right ventricular pacing on right ventricular mechanics and tricuspid regurgitation in patients with high-grade atrioventricular block and sinus rhythm (from the protection of left ventricular function during right ventricular pacing study). Am J Cardiol 2015 Dec 15;116(12):1875–82 .
  14. Mutlak D, Aronson D, Lessick J, Reisner SA, Dabbah S, Agmon Y. Functional tricuspid regurgitation in patients with pulmonary hypertension: is pulmonary artery pressure the only determinant of regurgitation severity? Chest 2009 Jan;135(1):115–21 .
  15. Novak M, Dvorak P, Kamaryt P, Slana B, Lipoldova J. Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes. Europace 2009 Nov;11(11):1510–6 .
  16. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019 Jan;32(1):1–64 .
  17. Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013 Jul;14(7):611–44 .
  18. Leibowitz DW, Rosenheck S, Pollak A, Geist M, Gilon D. Transvenous pacemaker leads do not worsen tricuspid regurgitation: a prospective echocardiographic study. Cardiology 2000 Jun;93(1-2):74–7 .
  19. Morgan DE, Norman R, West RO, Burggraf G. Echocardiographic assessment of tricuspid regurgitation during ventricular demand pacing. Am J Cardiol 1986 Nov 1;58(10):1025–9 .
  20. Kim JB, Spevack DM, Tunick PA, Bullinga JR, Kronzon I, Chinitz LA, et al. The effect of transvenous pacemaker and implantable cardioverter defibrillator lead placement on tricuspid valve function: an observational study. J Am Soc Echocardiogr 2008 Mar;21(3):284–7 .
  21. Fanari Z, Hammami S, Hammami MB, Hammami S, Shuraih M. The effects of right ventricular apical pacing with transvenous pacemaker and implantable cardioverter defibrillator on mitral and tricuspid regurgitation. J Electrocardiol 2015 Sep;48(5):791–7 .
  22. Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol 2017 May 9;69(18):2331–41 .
  23. Candinas R, Duru F, Schneider J, Luscher TF, Stokes K. Postmortem analysis of encapsulation around long-term ventricular endocardial pacing leads. Mayo Clin Proc 1999 Feb;74(2):120–5 .
  24. Robboy SJ, Harthorne JW, Leinbach RC, Sanders CA, Austen WG. Autopsy findings with permanent pervenous pacemakers. Circulation 1969 Apr;39(4):495–501 .
  25. Lin G, Nishimura RA, Connolly HM, Dearani JA, Sundt TM, Hayes DL. Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads. J Am Coll Cardiol 2005 May;45(10):1672–5 .
  26. Al-Bawardy R, Krishnaswamy A, Bhargava M, Dunn J, Wazni O, Tuzcu EM, et al. Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013 May;36(5):249–54 .
  27. Klutstein M, Balkin J, Butnaru A, Ilan M, Lahad A, Rosenmann D. Tricuspid incompetence following permanent pacemaker implantation. Pacing Clin Electrophysiol 2009 Mar;32(S1):S135–7 .
  28. Webster G, Margossian R, Alexander ME, Cecchin F, Triedman JK, Walsh EP, et al. Impact of transvenous ventricular pacing leads on tricuspid regurgitation in pediatric and congenital heart disease patients. J Interv Card Electrophysiol 2008 Jan;21(1):65–8 .
  29. Kaye GC, Linker NJ, Marwick TH, Pollock L, Graham L, Pouliot E, et al. Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study. Eur Heart J 2015 Apr 7;36(14):856–62 .
  30. Merchant FM, Mittal S. Pacing induced cardiomyopathy. J Cardiovasc Electrophysiol 2020 Jan;31(1):286–92 .
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2020.40
Loading
/content/journals/10.5339/qmj.2020.40
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): pacemaker , right heart failure and tricuspid regurgitation
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error