title: Tricuspid insufficiency does not increase early after permanent implantation of pacemaker leads.
abstract: BACKGROUND
  Interference between pacemaker (PM) lead and tricuspid apparatus may cause tricuspid regurgitation (TR). However, data regarding TR in patients with implanted PM are controversial. Our aim is to find out the degree of TR in a group of patients before and following PM implantation in a prospective manner.
  
  
  METHODS
  The study group consisted of the patients referred for implantation of permanent PM or implantable cardioverter defibrillator (ICD). All patients underwent two-dimensional and Doppler echocardiographic evaluation before and after device implantation. The severity of TR was qualitatively classified into four groups as normal or trivial, mild, moderate, or severe. All studies were reviewed for accuracy by a second independent interpreter.
  
  
  RESULTS
  Sixty-one patients (mean age 53 +/- 8 years, 44 male) referred for PM (n = 55) or ICD (n = 6) implantation consisted of the study population. Echocardiographic degree of TR was mild in 21 (70%), moderate in 7 (23%) and severe in 2 (7%) patients before PM implantation. Following device implantation, mild TR was noted in 23 (76%), moderate in 10 (33%), and severe in 2 (6%) cases. After the procedure, the TR severity was increased from normal/trivial to mild in 5 (16%) cases and from mild to moderate in 3 (10%). There was no worsening of the severity of TR in patients with moderate regurgitation following device implantation. The severity of TR did not change at a mean follow-up of 6 +/- 3 months.
  
  
  CONCLUSIONS
  New or worsening TR is relatively rare after PM implantation. It is not associated with an acute worsening or clinical deterioration. But echocardiographic follow-up is recommended to monitor other complications in chronic phase.
authors.affiliation: GATA Military Medical Hospital, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey. nkucukarslan@gata.edu.tr
authors.forename: Nezihi
authors.initials: N
authors.lastname: Kucukarslan
authors.forename: Ata
authors.initials: A
authors.lastname: Kirilmaz
authors.forename: Eralp
authors.initials: E
authors.lastname: Ulusoy
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yokusoglu
authors.forename: Nikola
authors.initials: N
authors.lastname: Gramatnikovski
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Ozal
authors.forename: Harun
authors.initials: H
authors.lastname: Tatar
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000628:therapy; D003324:Coronary Artery Disease / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology