Background: Although the presence of an RV lead is a potential cause of tricuspid regurgitation (TR), the clinical impact of significant lead-induced TR is unknown.
Objective: To evaluate the effect of significant lead-induced TR on cardiac performance and long-term outcome after cardioverter-defibrillator (ICD) or pacemaker implantation.
Methods: A retrospective cohort of 239 ICD (n=191) or pacemaker (n=48) recipients (age 60±14 years, 77% male) from a tertiary care university hospital, with an echocardiographic evaluation before and within 1-1.5 years after device implantation were included. Significant lead-induced TR was defined as TR worsening, reaching a grade ≥2 at follow-up echocardiography. During long-term follow-up (median 58, IQR 35-76 months), all-cause mortality and heart failure related events were recorded.
Results: Before device implantation, most patients had TR grade 1 or 2 (64.0%) or no TR (33.9%), but after lead placement, significant TR was seen in 91 patients (38%). Changes in cardiac volumes and function at follow-up were similar between patients with and without significant lead-induced TR, except for larger RV diastolic area (17±6mm(2) vs 16±5mm(2), p=0.009), larger right atrial diameter (39±10 mm vs 36±8 mm, p<0.001) and higher pulmonary arterial pressures (41±15 mm Hg vs 33±10 mm Hg, p<0.001) in patients with significant lead-induced TR. Patients with significant lead-induced TR had worse long-term survival (HR=1.687, p=0.040) and/or more heart failure related events (HR=1.641, p=0.019). At multivariate analysis, significant lead-induced TR was independently associated with all-cause mortality (HR=1.749, p=0.047) together with age, LVEF and percentage RV pacing.
Conclusions: Significant lead-induced TR is associated with poor long-term prognosis.
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http://dx.doi.org/10.1136/heartjnl-2013-304673 | DOI Listing |
Int J Cardiol
January 2025
Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy; Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy.
Pacing Clin Electrophysiol
January 2025
Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
This case details the successful implantation of a leadless pacemaker following the extraction of transvenous leads in a 72-year-old female patient with a complex cardiovascular history. The patient had undergone a series of cardiac interventions, including a recent percutaneous tricuspid valve repair with a metal clip implant due to severe regurgitation. After presenting with an infection at the pacemaker site, methicillin-resistant Staphylococcus hominis was identified, necessitating the removal of the entire pacing system.
View Article and Find Full Text PDFRev Cardiovasc Med
January 2025
Cardiovascular Department IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Humanitas Research Hospital, 20089 Rozzano, Milan, Italy.
Tricuspid regurgitation (TR) is a potentially lethal condition and represents a significant clinical challenge both for clinical and interventional cardiologists. Traditionally managed medically and surgically, transcatheter therapies are now an emerging option, especially in patients with prohibitive surgical risk due to age or comorbidities. Transcatheter tricuspid valve replacement (TTVR) is emerging as a potential solution for patients suffering from TR with positive clinical data supporting its use in a wide range of anatomies and clinical settings.
View Article and Find Full Text PDFRev Cardiovasc Med
January 2025
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Ganzhou Hospital, Guangdong Academy of Medical Sciences, 341000 Ganzhou, Jiangxi, China.
Background: Prognosis assessments for transcatheter aortic valve implantation (TAVI) patients remain challenging, particularly as the indications for TAVI expand to lower-risk patients. This study assessed the prognostic value of the tricuspid regurgitation impact on outcomes (TRIO) score in patients after TAVI.
Methods: This single-center study included 530 consecutive patients who underwent TAVI.
Cureus
December 2024
Cardiovascular Surgery, IMS Katsushika Heart Center, Tokyo, JPN.
An 85-year-old woman with long-standing atrial fibrillation and severe tricuspid regurgitation presented with worsening symptoms and massive right atrial enlargement (RAE). The patient experienced shortness of breath even during minimal exertion, such as walking within her house, which significantly impacted her daily activities. Surgical intervention, including tricuspid valve replacement and right atrial plication (RAP), led to significant symptomatic relief and improved pulmonary function.
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