Abstract 10963: Right Ventricular Lead-Induced Tricuspid Regurgitation is Associated with Long-Term Poor Prognosis
Background: The presence of a right ventricular (RV) lead is a known potential cause of tricuspid regurgitation (TR). However, the clinical impact of a lead-induced TR is not yet elucidated. The aim of the study was therefore to evaluate the effect of a significant lead-induced TR on 1) cardiac sizes and function and 2) on long-term outcome.
Methods: A total of 239 ICD (n=191) or pacemaker (n=48) recipients (mean age 60±14 years, 77% male), with an echocardiographic evaluation before and within 1-1.5 years after device implantation, were included. Induction of significant TR was defined as a TR worsening after RV lead placement, reaching a grade ≥2. During a median follow-up of 58 months (interquartile range 35-76 months) all-cause mortality was 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 induced in 91 patients (38%). Changes in cardiac sizes and function at follow-up were similar between patients with and without significant lead-induced TR except for RV diastolic area, right atrial size and systolic pulmonary arterial pressure (see interaction time and group p-values in Table). More importantly, patients with significant lead-induced TR showed worse overall survival on long-term follow-up (log rank p=0.038; Figure). Furthermore, significant lead-induced TR (HR 1.75, 95%CI 1.01-3.04, p=0.047) showed to be an independent predictor of all-cause mortality together with age, LV ejection fraction and pacing percentage, after adjustment for other clinical and echocardiographic characteristics.
Conclusion: Lead-induced significant TR is associated with long term poor prognosis.
- © 2012 by American Heart Association, Inc.