Abstract 15145: Location of Implantable Device Leads and Severity of Tricuspid Regurgitation: Value of 3D Echocardiography
Background: Currently, pacemaker and defibrillator implantation is guided by fluoroscopy, which does not allow targeted positioning of the lead relative to the tricuspid valve (TV) leaflets. Device-leads have been reported to cause TV regurgitation (TR) when they interfere with leaflet motion. We sought to determine: (1) the prevalence of different lead positions with respect to TV leaflets using 3D echocardiography (3DE), and (2) the relationship between lead location and severity of TR.
Methods: Transthoracic 3D full-volume images of the right ventricle (RV) and/or zoomed 3D images of the TV (Philips, iE33) were obtained in 121 adult patients with device-leads. Images were reviewed and cropped offline (Q-Lab, Philips) to follow the position of the lead relative to the valve leaflets. Severity of TR was estimated based on vena contracta (VC) measurements.
Results: In the majority, the lead was impinging on either the posterior (P) or septal (S) leaflet (43%) or was not interfering with leaflet motion when either mobile (M) or near the postero-septal (PS) commissure (50%). Mean VC of patients with leads impinging on the leaflet (A,P,S) was 0.64cm versus 0.22cm for leads located in the commissures (AP,AS, or PS) and 0.28cm for mobile (M) leads. 3DE depicted that leads impinging leaflet motion were associated with more severe TR, than those positioned near the commissures or in the center of the TV (Figure).
Conclusion: 3DE allows assessment of device-lead position enabling the diagnosis of a mechanism for TR in these patients. These findings suggest that 3DE guidance could be beneficial for lead implantation in a commissural position as a way to minimize TR.
- © 2013 by American Heart Association, Inc.