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. 2021 Jun;110(6):884-894.
doi: 10.1007/s00392-021-01812-3. Epub 2021 Feb 10.

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Martin Riesenhuber  1 , Andreas Spannbauer  1 , Marianne Gwechenberger  1 , Thomas Pezawas  1 , Christoph Schukro  1 , Günter Stix  1 , Matthias Schneider  1 , Georg Goliasch  1 , Anahit Anvari  1 , Thomas Wrba  2 , Cesar Khazen  3 , Martin Andreas  3 , Günther Laufer  3 , Christian Hengstenberg  1 , Mariann Gyongyosi  4   5
Affiliations

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Martin Riesenhuber et al. Clin Res Cardiol. 2021 Jun.

Abstract

Background: Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation.

Methods: Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years.

Results: In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27-3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51-7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16-2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09-2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42-3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07-3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04-1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02-1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31-2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25-2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17-3.71; P < 0.001).

Conclusions: Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival.

Keywords: Device complications; Pacemaker; Right ventricle; Tricuspid regurgitation; Valvular heart disease.

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Conflict of interest statement

Martin Andreas has served as a Proctor for Edwards and Abbott, served as an Advisor for Medtronic and reported receiving Institutional Grants from LSI, Abbott, Edwards, and Medtronic during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Fig. 1
Fig. 1
Tricuspid regurgitation before and after implantation of pacemaker. Sankey chart of grade of pre-existing TR with visualized flow to post-interventional TR after pacemaker implantation. Green: no/mild TR, orange: moderate TR, red: severe TR. Left: patients without RV dilatation. Right: patients with RV dilatation. Grades of TR are displayed in %. PM pacemaker, TR tricuspid regurgitation
Fig. 2
Fig. 2
Echocardiography images evaluating tricuspid regurgitation before and after pacemaker implantation. Representative images from transthoracic echocardiography (4-chamber view) evaluating tricuspid regurgitation before and after pacemaker implantation in a patient without right ventricular dilatation (left column) and in a patient with right ventricular dilatation (right column)
Fig. 3
Fig. 3
Survival of patients with/without right ventricular dilatation and with/without pacemaker lead-associated progression of tricuspid regurgitation. Kaplan–Meier plot of included patients with a 10-year follow-up. No. of events and patients at risk (No. at risk) are given in total numbers at year 0, 2, 4, 6, 8, and 10. RV right ventricle, TR tricuspid regurgitation
See this image and copyright information in PMC

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