Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up.
BACKGROUND
Although the presence of an RV lead is a potential cause of tricuspid regurgitation (TR), the clinical impact of significant lead-induced TR is unknown.


OBJECTIVE
To evaluate the effect of significant lead-induced TR on cardiac performance and long-term outcome after cardioverter-defibrillator (ICD) or pacemaker implantation.


METHODS
A retrospective cohort of 239 ICD (n=191) or pacemaker (n=48) recipients (age 60±14 years, 77% male) from a tertiary care university hospital, with an echocardiographic evaluation before and within 1-1.5 years after device implantation were included. Significant lead-induced TR was defined as TR worsening, reaching a grade ≥2 at follow-up echocardiography. During long-term follow-up (median 58, IQR 35-76 months), all-cause mortality and heart failure related events were recorded.


RESULTS
Before device implantation, most patients had TR grade 1 or 2 (64.0%) or no TR (33.9%), but after lead placement, significant TR was seen in 91 patients (38%). Changes in cardiac volumes and function at follow-up were similar between patients with and without significant lead-induced TR, except for larger RV diastolic area (17±6mm(2) vs 16±5mm(2), p=0.009), larger right atrial diameter (39±10 mm vs 36±8 mm, p<0.001) and higher pulmonary arterial pressures (41±15 mm Hg vs 33±10 mm Hg, p<0.001) in patients with significant lead-induced TR. Patients with significant lead-induced TR had worse long-term survival (HR=1.687, p=0.040) and/or more heart failure related events (HR=1.641, p=0.019). At multivariate analysis, significant lead-induced TR was independently associated with all-cause mortality (HR=1.749, p=0.047) together with age, LVEF and percentage RV pacing.


CONCLUSIONS
Significant lead-induced TR is associated with poor long-term prognosis.
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands.
Ulas
U
Höke
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Dominique
D
Auger
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Joep
J
Thijssen
Department of Biostatistics, Leiden University Medical Centre, Leiden, The Netherlands.
Ron
R
Wolterbeek
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Enno T
ET
van der Velde
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Eduard R
ER
Holman
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Victoria
V
Delgado
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Nina Ajmone
NA
Marsan
D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011379:Prognosis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D062606:Tertiary Care Centers; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
HEART FAILURE; QUALITY OF CARE AND OUTCOMES