Abstract
This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27–4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68–6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43–4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.
Highlights
Implantation of permanent pacemakers (PM) has gradually increased because of either prolonged life expectancy or increased incidence of cardiac surgery [1, 2]
The smaller right ventricular (RV) area in patients with PM-related TR (PMTR) seems to be associated with fewer cases of grade 1 or 2 Tricuspid regurgitation (TR) in that group than in the group without PMTR, owing to the criteria for dividing the two groups
The primary findings of this study were as follows: 1) the prevalence of PMTR was 9.7% in this study population during a median follow-up of 855 days; it was not uncommon; 2) the occurrence of PMTR was associated with atrial fibrillation and a history of open-heart surgery; and 3) PMTR was associated with poorer cardiovascular outcome
Summary
Implantation of permanent pacemakers (PM) has gradually increased because of either prolonged life expectancy or increased incidence of cardiac surgery [1, 2]. Tricuspid regurgitation (TR) is recognized as one of the lead-related complications [1, 3, 4]. PM-related TR (PMTR) can occur due to direct leaflet damage, such as leaflet perforation, lead entanglement, or lead. Pacemaker and tricuspid regurgitation publish, or preparation of the manuscript. There was no additional external funding received for this study
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