title: Right ventricular pacing increases tricuspid regurgitation grade regardless of the mechanical interference to the valve by the electrode.
abstract: OBJECTIVE
  The effect of right ventricular (RV) pacing on tricuspid regurgitation (TR) is debatable and is presumed to be related to an interference with valve closure by the electrode. The aim of the study was to determine the impact of pacing per se on TR grade.
  
  
  RESULTS
  The study group included 23 clinically stable patients (13 males; mean age 78 +/- 12 years) with a permanent pacemaker at the RV apex (83% DDD mode) and normal left ventricular function. They were all non-dependent on pacing and were otherwise in sinus rhythm. None had a primary dysfunction of the tricuspid valve. TR grade and RV size were assessed in two consecutive echo studies with and without active RV pacing. Results showed that active RV pacing was associated with an increase in TR severity (TR vena contracta: 0.4 +/- 0.2 vs. 0.2 +/- 0.2 cm, P < 0.001; TR jet area: 4.1 +/- 2.3 vs. 2.3 +/- 1.8 cm(2), P < 0.001). This was also reflected in a significant decrease in the number of patients with mild TR (P = 0.003) and increase in the number with moderate regurgitation (P = 0.02). There was no change in RV areas with pacing.
  
  
  CONCLUSIONS
  Active RV pacing is associated with a significant increase in TR grade. This effect is not induced by acute changes in the RV area and is unrelated to an interference with leaflet closure by the electrode.
authors.affiliation: Rabin Medical Center, Beilinson Hospital, 36 Jabotinsky Street, Petach Tikva 49100, Israel. vaturi@inter.net.il
authors.forename: Mordehay
authors.initials: M
authors.lastname: Vaturi
authors.forename: Jairo
authors.initials: J
authors.lastname: Kusniec
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Roman
authors.initials: R
authors.lastname: Nevzorov
authors.forename: Idit
authors.initials: I
authors.lastname: Yedidya
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisenberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Monakier
authors.forename: Boris
authors.initials: B
authors.lastname: Strasberg
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000473:pathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right