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.
Keywords: Tricuspid regurgitation; Transvenous permanent pacemaker implantation; Heart failure hospitalization
Background
In 1959, an endocardial transvenous lead was firstly introduced for permanent cardiac pacing, which has great benefits in reducing cardiac morbidity and mortality related to symptomatic bradycardia1, 2. However, the introduction of transvenous right ventricular pacing leads across the tricuspid valve can be associated with the development of tricuspid regurgitation (TR) and elevated tricuspid regurgitation pressure gradient (TRPG). Indeed, the prevalence of TR was increased in patients with transvenous permanent pacemaker (PPM) compared with the general population3. One previous report demonstrated that 21.2% of patients developed worsening TR degree after the transvenous lead implantation and a higher rate of worsening TR in patients with implantable cardioverter defibrillator (ICD) lead compared with PPM4. Another study showed that device type and number of leads placed did not affect the worsening degree of post-implant TR5.
The underlying mechanisms of transvenous cardiac pacing-related TR is not fully understood. Several mechanisms have been proposed that included a mechanical effect of the lead interfering the motion of the tricuspid leaflets, RV pacing-induced desynchronization6, 7 and leads related tricuspid leaflet injury or perforation, entanglement, impingement, or adherence to the tricuspid valve 6. One study reported that worsening TR occurred only in the chronic phase over 2 years, whereas another study reported a temporal trend toward increasing TR both acutely and chronically over 4 years after cardiac devices implantation 5, 8. Therefore, the prevalence of increased degree of post-implant TR remains conflicting. Moreover, the association of post-implant TR and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and abnormal TRPG remains unclear. Accordingly, we conducted this study to assess the prevalence of TR after cardiac device implantation and determine its clinical significance on HF hospitalization in a large retrospective cohort after transvenous ventricular-based PPM implantation.