Predictors of severe tricuspid regurgitation in patients with permanent pacemaker or automatic implantable cardioverter-defibrillator leads

Abstract

Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ±6 vs 81 ±8 yr; P = 0.83), sex (male, 42% vs 46%; P = 0.78), and left ventricular ejection fraction (0.60 ±0.06 vs 0.58 ± 0.05; P = 0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P < 0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P = 0.03) and duration of lead placement (odds ratio=1.5/yr; P = 0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs.

Keywords: Atrial fibrillation/complications; cardiac pacing, artificial/adverse effects; defibrillators, implantable/adverse effects; disease progression; echocardiography; electrodes, implanted/adverse effects; pacemaker, artificial/adverse effects; risk factors; tricuspid valve insufficiency/diagnosis/etiology; ventricular dysfunction, right/diagnosis/etiology.

Fig. 1 Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator leads had larger A) right atrial (RA) volumes and B) tricuspid annular diameters than did the control subjects (both P < 0.001).

Fig. 2 The prevalence of atrial fibrillation in patients with permanent pacemaker or automatic implantable cardioverter-defibrillator leads was 92%, compared with 65% in the control subjects (P = 0.01).

Fig. 3 The median duration of device placement in patients with permanent pacemaker (PPM) or automatic implantable cardioverter-defibrillator (AICD) leads was 49.5 months, compared with 5 months in the control subjects (P < 0.001).