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. 2020 Jun 26;15(6):e0235230.
doi: 10.1371/journal.pone.0235230. eCollection 2020.

Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

Jiwon Seo  1 , Dae-Young Kim  1 , Iksung Cho  1 , Geu-Ru Hong  1 , Jong-Won Ha  1 , Chi Young Shim  1
Affiliations

Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

Jiwon Seo et al. PLoS One. .

Abstract

This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27-4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68-6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43-4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the study.
Fig 2
Fig 2
Kaplan–Meier curves for the primary outcome-free survival according to the presence of pacemaker-related tricuspid regurgitation A. overall patients, B. patients without previous open-heart surgery, and C. patients with previous open-heart surgery.
See this image and copyright information in PMC

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