Abstract 16528: Significant Increase in Tricuspid Regurgitation Following Transvenous Device Lead Implantation
Introduction: Increase in tricuspid regurgitation (TR) following transvenous lead placement for permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) has been reported in case reports and small series, but has not been systematically studied. The purpose of this study was to investigate the incidence, risk factors and prognostic implications of significant increase in TR (SITR) following transvenous placement of PPMs or ICDs.
Methods: We studied 343 consecutive patients who had evaluation of TR by echocardiography prior to, and following transvenous placement of PPMs or ICDs. TR severity was assessed on a 7-grade scale (none, trace, mild, mild to moderate, moderate, moderate to severe, severe). SITR was defined as an increase in the severity of TR by ≥2 grades. Study outcomes were all-cause death and a composite outcome of all-cause death, tricuspid surgery, ventricular assist device placement or heart transplantation.
Results: SITR was seen in 44 patients (12.8%) over a median follow up of 3.9 years. Independent predictors of SITR were estimated pulmonary artery systolic pressure (PASP) (HR 1.065; p<0.001) and right atrial (RA) area (HR 1.101; p=0.001). On unadjusted Kaplan-Meier survival analyses, patients with SITR had higher rates of all-cause death (31.8% vs. 19.8%; p = 0.047) (Figure; Panel A) and composite outcome (43.2% vs. 23.0%; p = 0.002) (Panel B). However, on multivariate Cox regression analyses, SITR was not associated with all-cause death (p = 0.666) (Panel C) or the composite outcome (p = 0.141) (Panel D).
Conclusions: SITR following transvenous placement of PPMs or ICDs was seen in 1 in 8 patients. Independent risk factors for SITR were estimated PASP and RA size. While SITR was associated with higher rates of adverse outcomes on unadjusted survival analyses, it had no independent incremental prognostic value on multivariate-adjusted analyses.
- © 2013 by American Heart Association, Inc.