Tricuspid incompetence following permanent pacemaker implantation.
OBJECTIVE
Severe tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) has been described in small series of patients, though its incidence is not known.


METHODS
We retrospectively analyzed the data of 545 patients who underwent PPI and had Doppler echocardiograms performed before and after the procedure. We excluded 135 patients who had > or =moderate TI on the 1st Doppler echocardiogram.


RESULTS
Group 1 included 75 patients (18.3%) who had a >2 grades worsening of TI, and group 2 included 335 patients (82%) with <2 grade increase in TI after PPI. Patients in group 1 were 77 +/- 7 years of age, versus 72 +/- 10 years in group 2 (P < 0.001). There was no difference in left ventricular size and function. The TI gradient before PPI was higher in group 2 (25 +/- 13 mmHg versus 19 +/- 12 mmHg [P < 0.001]), though within the normal range in both groups. The mitral E/A ratio was 0.98 in group 1 versus 1.42 in group 2 (P < 0.001). The systolic TI gradient after implantation was 42 +/- 12 mmHg in group 1, versus 33 +/- 8 mmHg in group 2 (P < 0.001).


CONCLUSIONS
Worsening of TI after PPI was not rare and was observed more often in older patients, with abnormal LV relaxation and who developed pulmonary hypertension after the procedure.
Klutstein
Marc
M
Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with Hebrew University of Jerusalem, Israel.
Balkin
Jonathan
J
Butnaru
Adi
A
Ilan
Michael
M
Lahad
Amnon
A
Rosenmann
David
D
D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data*; D019736:Prostheses and Implants / Q000706:statistics & numerical data*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology*