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Pacemaker-induced tricuspid regurgitation is uncommon immediately post-implantation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Prior studies report permanent pacemaker (PPM)-induced tricuspid regurgitation (TR) in up to one third of cases late post-implantation. We sought to assess the extent of immediate PPM-induced TR.

Methods

Forty patients undergoing PPM implant were prospectively enrolled. Patients with pre-existing moderate or severe TR or an RVSP >50 mmHg were excluded. Pre- and immediate post-implantation transthoracic echocardiography (TTE) analyzed TR grade according to established methods. 3D TTE was utilized to determine lead position in relation to tricuspid leaflets as well as lead mobility across the TV.

Results

Of 40 patients, four were excluded due to baseline moderate TR (n = 3) or RVSP >50 mmHg (n = 1). In the remaining cohort (n = 36), immediate post-implantation TTE showed no increase in TR grade in 30 patients (83%), whereas a one-grade increase from no/trace to mild occurred in six (17%) others. In no patient did immediate moderate or severe TR develop. Exclusive RV pacing was present in 47% of the patients; however, only two of the six patients with increased TR were paced. 3D TTE identified lead position in 92% of the cases—more than 50% of the cases showed RV lead distribution in the middle or post eroseptal commissure of the TV. Lead immobility was seen in only three of the six patients with increased TR.

Conclusions

These findings show that significant PPM-induced TR is uncommon immediately post-implantation and, when it occurs, causes no greater than mild TR. RV pacing and lead mobility do not correlate with worsening of TR. 3D TTE is highly reliable at identifying lead position.

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Acknowledgements

The authors thank the following sonographers who acquired images for the study: Nada Popa, Nevien Hanna, Besjana Mani, Sandra Senkowski, Patricia Bailey, and John Alban.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Beaumont Health, 3601 West 13 Mile Road, Royal Oak, MI, 48073, USA

    Daniel P. Rothschild, James A Goldstein, Nathan Kerner, Amr E. Abbas, Meet Patel & Wai Shun Wong

  2. Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, 48309, MI, USA

    James A Goldstein, Nathan Kerner, Amr E. Abbas & Wai Shun Wong

Authors
  1. Daniel P. Rothschild
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  2. James A Goldstein
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  3. Nathan Kerner
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  4. Amr E. Abbas
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  5. Meet Patel
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  6. Wai Shun Wong
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Contributions

Drs Rothschild, Goldstein, Kerner, Abbas, and Wong: study concept, design, data analysis, and interpretation. Drs Rothschild, Goldstein, Kerner Abbas, and Wong: drafting article, critical revision. Drs Rothschild and Patel: data collection. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Wai Shun Wong.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

Non-applicable

Ethical approval

The Beaumont Research Institute IRB approved the study protocol 1/22/16 and also conducted a First Subject Monitoring review 3/10/16. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Rothschild, D.P., Goldstein, J.A., Kerner, N. et al. Pacemaker-induced tricuspid regurgitation is uncommon immediately post-implantation. J Interv Card Electrophysiol 49, 281–287 (2017). https://doi.org/10.1007/s10840-017-0266-2

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  • DOI: https://doi.org/10.1007/s10840-017-0266-2

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