title: Clinical significance of increased tricuspid valve incompetence following implantation of ventricular leads.
abstract: OBJECTIVE
  Cardiac rhythm management devices (CRMD) require a ventricular lead to be placed across the tricuspid valve. Tricuspid regurgitation (TR) is an under-recognized clinical complication of lead implantation and its clinical significance is unknown. We studied the incidence of hospitalizations for congestive heart failure (CHF) exacerbation among patients with worsening TR after ventricular lead implantation.
  
  
  METHODS
  We reviewed 148 patients (age 68 ± 15) that received a CRMD. TR and pulmonary artery systolic pressure (PASP) measured by Doppler echocardiography before and after CRMD implantation were analyzed. Hospitalizations for CHF exacerbation post-implantation were counted.
  
  
  RESULTS
  Follow-up was 32 ± 14 months. Ninety-nine (67%) patients had no change, 24 (16%) slight, and 9 (6%) significant increase in TR after CRMD implantation, while 13 (9%) patients had slight and 3 (2%) significant improvement. Patients with a significant increase in TR had higher incidence of hospitalizations (1.7 ± 0.5) compared to patients with slight (0.8 ± 1; p = 0.006) or no increase (0.5 ± 1; p = 0.0002) in TR. Patients with significant increase in TR had a greater change in PASP (25 mmHg; p = 0.002) after device implantation compared to those with a slight (10 mmHg; p = 0.002) or no increase (0.7 mmHg; p = 0.17).
  
  
  CONCLUSIONS
  Increased TR following CRMD implantation is relatively common (33%) and correlated with subsequent risk of hospitalization for heart failure. A preventive strategy and close monitoring for development or worsening of CHF after CRMD implantation may help prevent hospital admissions.
authors.forename: Giselle A
authors.initials: GA
authors.lastname: Baquero
authors.forename: Pradeep
authors.initials: P
authors.lastname: Yadav
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Skibba
authors.forename: Javier E
authors.initials: JE
authors.lastname: Banchs
authors.forename: Latoya N
authors.initials: LN
authors.lastname: Linton-Frazier
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Lengerich
authors.forename: Soraya M
authors.initials: SM
authors.lastname: Samii
authors.forename: Erica
authors.initials: E
authors.lastname: Penny-Peterson
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Wolbrette
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Luck
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Naccarelli
authors.forename: Mario D
authors.initials: MD
authors.lastname: Gonzalez
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D015897:Comorbidity; D004567:Electrodes, Implanted / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006352:Heart Ventricles / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
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