Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long term follow-up

Abstract

Background: The presence of a right ventricular (RV) lead is a potential cause of tricuspid regurgitation (TR). However, the clinical impact of significant lead-induced TR is not yet elucidated. We aimed at evaluating the effect of significant lead-induced TR on 1) cardiac performance and 2) long-term outcome of patients with cardioverter-defibrillator or pacemaker. Methods: A total of 239 cardioverter-defibrillator (n=191) or pacemaker (n=48) recipients (age 60±14 years, 77% male), with an echocardiographic evaluation before and within 1-1.5 years after device implantation, were included. Lead-induced significant TR was defined as a TR worsening and reaching a grade ≥2 at follow-up echocardiography. During long-term follow-up (median 58, IQR 35-76 months) all-cause mortality and heart failure related events were recorded. Results: Before device implantation, most patients had TR grade 1 or 2 (64%) or no TR (34%), but after lead placement, significant TR was observed in 91 patients (38%). Changes in cardiac chambers size and function at follow-up were similar between patients with and without significant lead-induced TR, except for increased RV diastolic area (17±6 vs. 16±5, p=0.009), right atrial diameter (39±10 vs. 36±8mm, p<0.001) and pulmonary arterial pressures (41±15 vs. 33±10mmHg, p<0.001) in patients with significant lead-induced TR. Patients with significant lead-induced TR showed worse long-term outcome in terms of overall survival (p=0.038) and/or combined with heart failure related events (p=0.017). At multivariate analysis, significant lead-induced TR was independently associated with all-cause mortality (HR 1.75, 95% CI: 1.01-3.04, p=0.047) together with age, LV ejection fraction and RV pacing percentage. ![Figure][1] Overall survival Conclusion: Lead-induced significant TR is associated with long-term poor prognosis. [1]: pending:yes