Tricuspid Valve Regurgitation Following Temporary or Permanent Endocardial Lead Insertion, and the Impact of Cardiac Resynchronization Therapy



Masoud Sadreddini a, Michelle J Haroun a, Lisanne Buikema b, Carlos Morillo a, Sebastian Ribas a, Syamkumar Divakaramenon a, Stuart J Connolly a, Robby Nieuwlaat c, Eva M Lonn a, Jeff S Healey a, Hisham Dokainish a, *
a Department of Medicine, McMaster University, Hamilton, Ontario, Canada
b Department of Medicine, University of Groningen, The Netherlands
c Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada


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© Sadreddini et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-com mercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the McMaster University, Director of Medical Diagnostic Units and Echocardiography, Hamilton Health Sciences, 237 Barton St. E., CVSRI #C3 111, Hamilton, ON, Canada L8L 2X2; Tel: 905-527-4322; ext: 40327; Fax: 905-577-1474; E-mail: hisham.dokainish@phri.ca


Abstract

Background:

While some studies indicate that permanent pacemaker implantation is associated with development of tricuspid regurgitation (TR), other studies indicate no association.Little is known about the impact of temporary lead insertion during ablation procedures, or whether therapy (CRT) prevents TR post-device implantation.

Hypothesis:

We hypothesized that permanent, but nottemporary endocardial leads, are associated with development of TR, and that CRT would prevent (physiologic) TR.

Methods:

We performed a retrospective study of consecutive patients who underwent first device or radiofrequency catheter ablation over a 12-month period at a single, tertiary academic center who underwent pre- and post-procedure echocardiography.

Results:

In the 89 patients in the device group, the degree of TR significantly increased ≥ 1 grade post-permanent lead implantation: 9 had less TR, 46 were unchanged, and 34 had more TR(p=0.005). TR increased in the 62 patients who underwent device implantation without CRT (p=0.005), but did not increase in the 27 patients with CRT (p=0.47). In the 66 patients in the ablation group, there was no significant change in TR post-ablation: 8 had less TR, 48 were unchanged, and 10 had more TR (p=0.31).

Conclusion:

Permanent endocardial lead implantation was associated with an increase in TR; however, patients who underwent device implantation with CRT did not have an increase in TR.Temporary lead insertion during ablation was not associated with changes in the degree of TR. A large, prospective study is needed to accurately define the incidence and exact mechanisms of permanent endocardial lead-related TR.

Keywords: Cardiac resynchronization, echocardiography, implantable cardiac defibrillators, pacemakers, tricuspid regurgitation..