title: Percutaneous pacemaker or implantable cardioverter-defibrillator lead removal in an attempt to improve symptomatic tricuspid regurgitation.
abstract: OBJECTIVE
  Pacemaker and implantable cardioverter-defibrillator (ICD) leads can cause tricuspid valve regurgitation (TR). Few data are available on the best management of significant TR that develops after pacemaker or ICD implantation and regarding any benefits of right ventricular (RV) lead extraction. We sought to determine the impact of RV lead removal on lead-induced TR.
  
  
  RESULTS
  We reviewed all patients between 1 January 2000 and 31 December 2010 at the tertiary care hospital who had a preoperative indication of TR and underwent percutaneous extraction of an RV lead with the intent of trying to correct moderate or severe TR. Pre- and post-procedure echoes and clinical data were retrospectively reviewed. In the four patients identified, the RV lead was removed and placed in the coronary sinus to try to improve moderate or severe TR due to lead impingement. There was no significant improvement in the degree of TR except one patient where TR improved slightly from moderate to mild-moderate. All patients had a dilated tricuspid valve annulus by the time of lead extraction. Tricuspid annulus dilatation appeared to account for the persistent TR after RV lead removal.
  
  
  CONCLUSIONS
  A greater degree of tricuspid valve annulus dilatation may be a marker and mechanism for irreversible lead-induced TR. Further studies are needed to determine whether surgical tricuspid valve repair or replacement combined with RV lead extraction would result in better outcomes than a percutaneous lead extraction approach.
authors.affiliation: Division of Cardiovascular Diseases,  Mayo Clinic, 200 First St SW, Rochester, MN 55905,  USA.
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Nazmul
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
authors.forename: Grace
authors.initials: G
authors.lastname: Lin
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Brian D
authors.initials: BD
authors.lastname: Powell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000401:mortality; D017147:Defibrillators, Implantable; D020878:Device Removal; D018618:Echocardiography, Doppler, Color; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*