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

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.

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

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

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