title: Impact of implantable transvenous device lead location on severity of tricuspid regurgitation.
abstract: BACKGROUND
  Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR.
  
  
  METHODS
  A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis.
  
  
  RESULTS
  Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively.
  
  
  CONCLUSIONS
  Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maffessanti
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Anuj
authors.initials: A
authors.lastname: Mediratta
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Megan
authors.initials: M
authors.lastname: Yamat
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Lynn
authors.initials: L
authors.lastname: Weinert
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Moss
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Hemal M
authors.initials: HM
authors.lastname: Nayak
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Burke
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Eric
authors.initials: E
authors.lastname: Kruse
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois. Electronic address: rlang@medicine.bsd.uchicago.edu.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D014680:Veins / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: Intracardiac defibrillator; Pacemaker; Three-dimensional echocardiography; Tricuspid regurgitation