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Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient after Transvenous Permanent Pacemaker Implantation
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  • Wei-Chieh Lee,
  • Hsiu-Yu Fang,
  • Huang-Chung Chen,
  • Yung-Lung Chen,
  • Tzu-Hsien Tsai,
  • Kuo-Li Pan,
  • Yu-Sheng Lin,
  • Wen-Hao Liu,
  • Mien-Cheng Chen
Wei-Chieh Lee
Chang Gung Memorial Hospital Kaohsiung Branch
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Hsiu-Yu Fang
Chang Gung Memorial Hospital Kaohsiung Branch
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Huang-Chung Chen
Chang Gung Memorial Hospital Kaohsiung Branch
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Yung-Lung Chen
Chang Gung Memorial Hospital Kaohsiung Branch
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Tzu-Hsien Tsai
Chang Gung Memorial Hospital Kaohsiung Branch
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Kuo-Li Pan
Chang Gung Memorial Hospital Kaohsiung Branch
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Yu-Sheng Lin
Chang Gung Memorial Hospital Kaohsiung Branch
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Wen-Hao Liu
Chang Gung Memorial Hospital Kaohsiung Branch
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Mien-Cheng Chen
Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine
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Abstract

Background The association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation. Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant. Results 198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG. Group 1 had l larger changes in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2 without progressive post-implant TR. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) and post-implant left atrial dimension (HR: 1.076; 95% CI: 1.038-1.114; p < 0.001) were independent predictors of progressive post-implant TR. Conclusion After a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG and larger post-implant LA dimension were independent predictors of progressive post-implant TR.