Prospective Study of Tricuspid Regurgitation Associated With Permanent Leads After Cardiac Rhythm Device Implantation

Tricuspid regurgitation (TR) has been associated with cardiac rhythm device (CRD) implantation with intracardiac lead insertion. However, data on the incidence of postdevice TR are limited and largely from retrospective studies. We hypothesized that permanent lead implantation would be associated wi...

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Published in:Canadian journal of cardiology 2019-04, Vol.35 (4), p.389-395
Main Authors: Van De Heyning, Caroline M., Elbarasi, Esam, Masiero, Simona, Brambatti, Michela, Ghazal, Sami, Al-Maashani, Said, Capucci, Alessandro, Leong, Darryl, Shivalkar, Bharati, Saenen, Johan B., Miljoen, Hielko P., Morillo, Carlos A., Divarakarmenon, Syamkumar, Amit, Guy, Ribas, Sebastian, Baiocco, Erika, Maolo, Alessandro, Romandini, Andrea, Maffei, Simone, Connolly, Stuart J., Healey, Jeff S., Dokainish, Hisham
Format: Article
Language:English
Subjects:
Aged
Canada - epidemiology
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Disease Progression
Echocardiography
Female
Heart Atria - diagnostic imaging
Humans
Male
Multivariate Analysis
Pacemaker, Artificial
Prevalence
Prospective Studies
Severity of Illness Index
Stroke Volume
Tricuspid Valve Insufficiency - classification
Tricuspid Valve Insufficiency - epidemiology
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Summary:Tricuspid regurgitation (TR) has been associated with cardiac rhythm device (CRD) implantation with intracardiac lead insertion. However, data on the incidence of postdevice TR are limited and largely from retrospective studies. We hypothesized that permanent lead implantation would be associated with an increase in TR. We prospectively included consecutive patients with a clinical indication for CRD. Patients underwent transthoracic echocardiography 1 month before and 1 year after CRD implantation. A total of 328 patients were prospectively enrolled (69 ± 15 years, 38% female). Echocardiograms before and 1 year after CRD were available in 290 patients (15 died, 23 lost to follow-up). Compared with baseline, there was a significant change in TR grade 1 year after CRD insertion (no/trivial TR: 66% vs 29%; mild TR: 29% vs 61%; moderate TR: 3% vs 8%; severe TR 2% vs 2%; P < 0.001 for an increase in TR by at least 1 grade). Compared with baseline, there was a higher prevalence of moderate or severe TR in the 247 patients with CRD without cardiac resynchronization therapy (4% vs 10%, P = 0.004), but no progression in the 43 patients who received cardiac resynchronization therapy (14% vs 11%, P = 1). Multivariable analysis in the patients with less than moderate TR at baseline (n = 274) showed that only a history of atrial fibrillation was independently associated with progression to moderate or severe TR after correction for baseline TR grade (P = 0.013). One year after endocardial lead insertion, there was a 5% increase in the prevalence of moderate or severe TR, which may be clinically relevant. La régurgitation tricuspidienne (RT) a été associée à l’implantation d'un dispositif cardiaque (DC) muni d’une sonde intracardiaque. Toutefois, les données sur l’incidence de la RT après l’implantation du dispositif sont limitées et proviennent en grande partie des études rétrospectives. Nous avons posé l’hypothèse que l’implantation d’une sonde permanente serait associée à une augmentation de la RT. Nous avons inclus de manière prospective les patients consécutifs chez qui un DC était indiqué sur le plan clinique. Les patients ont subi une échocardiographie transthoracique 1 mois avant et 1 an après l’implantation du DC. Un total de 328 patients ont été inscrits de manière prospective (69 ± 15 ans, 38 % de femmes). Les échocardiogrammes de 290 patients (15 sont morts, 23 ont été perdus de vue au cours du suivi) 1 mois avant et 1 an après l’implantation du DC étaient
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2018.11.014