Impact of leadless pacemaker therapy on tricuspid regurgitation

Abstract

Abstract Background The association between conventional transvenous pacemaker leads and tricuspid regurgitation (TR) has been well described. Leadless pacemakers (LP) have risen as an alternative to conventional transvenous pacemakers in order to avoid lead associated complications. Prior studies have included a mix of leadless pacemaker types including: Nanostim, Micra, etc. This is the first study exploring only one model of LP. Purpose The purpose of the study was to investigate the impact of leadless pacemaker therapy on tricuspid regurgitation. Methods Adult patients who underwent Micra leadless pacemaker implantation at a single center from 2016 to 2022 were identified retrospectively. Patients who had an echocardiogram prior to the procedure and within 24 months after the procedure were included. Echocardiograms were reviewed to assess for change in presence or in severity of tricuspid regurgitation. Results There were 310 patients in total who received LP at our hospital. Of these, 104 met inclusion criteria. 189 patients were excluded because they did not have an echocardiogram before or after the procedure. 17 more were excluded because their post procedure echo was done more than 2 years later. The average age of our patient population was 78. Of the 104 total patients, 97 had some TR before LP implantation (Trace 41%, Trace-Mild 4%, Mild 31%, Mild-Moderate 7%, Moderate 13%, Moderate-Severe 1%, Severe 2%). After implantation, 34 patients had worsening TR (33%), 23 patients had improved TR (22%), and 47 patients had no change in TR severity (45%) p=0.053. Conclusion Overall, the results did not show a statistically significant improvement or worsening in TR severity after LP implantation. Further studies should be done to validate these findings, to evaluate the effect of a larger sample size, and to examine whether controlling for additional confounders maintains or contradicts this finding.