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.