Do Implantable Cardioverter Defibrillators (ICD) Cause Tricuspid Regurgitation? A Retrospective Study

Abstract

Background: ICDs are an important treatment option in the management of arrhythmias post myocardial infarction. One complication of having an ICD is tricuspid regurgitation (TR), attributed to the passage of the transvenous lead across the tricuspid valve (TV). There is conflicting evidence regarding the effect of the ventricular lead on the TV with some evidence suggesting that the function is significantly compromised. Aim: To examine the impact of ICD leads on the TV by assessing the severity of TR in both acute (<6 months) and chronic (>12 months) phases after insertion. Methods: A retrospective review of patients who underwent percutaneous coronary intervention for an acute STEMI in a tertiary referral teaching hospital (2004–10), with left ventricular ejection fraction <40% at day 3 post infarct as determined by a gated heart pool scan or transthoracic echocardiography (TTE). Of the 299, 59 had an ICD inserted following detection of spontaneous or induced ventricular tachycardia on electrophysiological study within seven days of the infarct vs 241 who did not have ICD. Only subjects who had a TTE pre- and post-implantation of AICD TTE were considered. Results: In the case group 19 had TTEs at all three time points, 24 had TTES pre implant and within six months and the remaining 29 had echos pre implant and >12 months after implantation. The odds ratio of worsening TR at long term follow up compared to short term follow up was 1.6 (95% CI 0.7–3.6, p = 0.28 NS). Conclusion: The presence of an ICD does not appear to worsen tricuspid regurgitation with an odds ratio of 1.6 which was not statistically significant.