Abstract 237: The Effects of Transvenous Pacemaker and Implantable Cardioverter Defibrillator Lead Placement on Tricuspid Regurgitation
Background: The incidence of new or worsening tricuspid regurgitation (TR) after permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) lead placement has not been well investigated.
Objective: We compared echocardiograms pre- and post-implantation to determine if PPM or ICD lead placement causes or worsens TR.
Methods and Results: We reviewed the charts of all patients undergoing PPM or ICD lead placement in our electrophysiology laboratory from December 2001 to December 2006. Of these, we compared the severity and frequency of TR before and after lead insertion in 206 patients (120 with PPM and 86 with ICD) who had baseline echocardiography within 6 months before, and a follow up study at least 6 months after lead insertion. The mean age was 74±14 years; 56% were men. The follow-up period was 29±19 months. TR was graded as absent or trace, mild, moderate, or severe. Prior to implant, 34.5%, 45.1%, 16.0%, and 4.4% of patients had absent or trace, mild, moderate, or severe TR. Post-implant, the respective frequencies were 13.6%, 52.9%, 23.8%, and 9.7% (Chi-square 54.6, P<0.001). The change in TR severity was also statistically significant using a pairwise t-test, with TR grade as a continuous variable (p <0.001). TR worsened by at least one grade after lead insertion in 44.7% patients; TR grade decreased in 12.6%. Pre- and post-implant changes in TR severity did not differ with respect to lead type (ICD vs. PPM).
Conclusion: Our data shows that, the implantation of the transvenous PPM or ICD leads induces and aggravates tricuspid regurgitation.