Clinical utility of three-dimensional echocardiography in the evaluation of tricuspid regurgitation induced by implantable device leads.

Abstract

Implantable device leads could cause tricuspid regurgitation (TR) by interfering with leaflet motion. This study evaluated the feasibility of using three-dimensional transthoracic echocardiography (3DTTE) to identify lead-induced tricuspid regurgitation (LITR). 3DTTE full-volume images of the right ventricle (RV) and zoomed images of the tricuspid valve were obtained in 207 patients with implanted devices, and the images were analyzed. TR severity was estimated based on measurements of the proximal isovelocity surface area (PISA) radius. 3DTTE clearly identified the course and position of the leads in 74% of the patients. The lead tips were located in the RV apex or outflow tract in 95% of patients and in the interventricular septum (IVS) in 5% of patients. At the tricuspid annular level, 25% of leads were impinging on a leaflet, 41% were located in the commissure of two leaflets, and 34% were in the middle of the tricuspid orifice. 3D images revealed that when the lead tip was in the IVS or the lead was impinging on a leaflet, the device lead was more likely to interfere with leaflet mobility (P<.05). Interfering leads were associated with more significant TR than noninterfering leads (P<.05). 3DTTE showed a clear association between lead interference and TR worsening after lead placement. 3DTTE guidance should be considered for the placement of leads.