PO-05-028 EVOLUTION IN SIGNIFICANT TRICUSPID REGURGITATION AFTER LEADLESS PACEMAKER IMPLANTATION

Abstract

Lead induced tricuspid regurgitation (TR) is a known complication of cardiac implanted electronic devices and has been associated with increased rates of right heart failure, hospitalization, and death. Leadless pacemakers eliminate lead impingement on the valve leaflets but there are other mechanisms by which pacing may worsen TR. Data on the change in TR severity after leadless pacemaker implantation in patients with pre-existing significant TR are limited. To determine the change in TR after implantation of a leadless pacemaker system in patients with pre-existing moderate or greater TR. We performed a retrospective review of all leadless pacemaker implantations (Micra™ TPS, Medtronic) done at two hospitals between 2018 and 2021. Echocardiograms were obtained at baseline and at least 21 days after leadless pacemaker placement. Quartiles of TR were defined as none, mild, moderate, and severe. Patients were included for analysis if they had moderate or greater TR prior to implantation. Patients with a history of tricuspid valve surgery were excluded. Descriptive statistics were used to define the change in severity of TR after leadless pacemaker placement. Improvement was defined as decline in TR by at least one grade. Twenty-eight patients were included for analysis. Mean age was 79 years (range 57-97 years) and 61% of patients were female. Median RV pacing burden was 98%. The mean time from the procedure to follow up echo was 288 days (range 21 days-2.8 years). In 23 (83%) of patients TR remained stable or improved (Figure 1). Among the 21 patients with moderate TR, 5 (24%) developed severe TR while 9 (43%) had improvement. Four (57%) of the patients with severe TR had improvement. In this selected group of patients with pre-existing moderate or greater TR who underwent leadless pacemaker implantation, the majority unchanged or improved TR at follow up. These results suggest that leadless pacemakers do not adversely affect degree of TR. Future studies are planned in a larger, prospective population.