title: Tricuspid valve regurgitation following temporary or permanent endocardial lead insertion, and the impact of cardiac resynchronization therapy.
abstract: BACKGROUND
  While some studies indicate that permanent pacemaker implantation is associated with development of tricuspid regurgitation (TR), other studies indicate no association.Little is known about the impact of temporary lead insertion during ablation procedures, or whether therapy (CRT) prevents TR post-device implantation.
  
  
  OBJECTIVE
  We hypothesized that permanent, but nottemporary endocardial leads, are associated with development of TR, and that CRT would prevent (physiologic) TR.
  
  
  METHODS
  We performed a retrospective study of consecutive patients who underwent first device or radiofrequency catheter ablation over a 12-month period at a single, tertiary academic center who underwent pre- and post-procedure echocardiography.
  
  
  RESULTS
  In the 89 patients in the device group, the degree of TR significantly increased ≥ 1 grade post-permanent lead implantation: 9 had less TR, 46 were unchanged, and 34 had more TR(p=0.005). TR increased in the 62 patients who underwent device implantation without CRT (p=0.005), but did not increase in the 27 patients with CRT (p=0.47). In the 66 patients in the ablation group, there was no significant change in TR post-ablation: 8 had less TR, 48 were unchanged, and 10 had more TR (p=0.31).
  
  
  CONCLUSIONS
  Permanent endocardial lead implantation was associated with an increase in TR; however, patients who underwent device implantation with CRT did not have an increase in TR.Temporary lead insertion during ablation was not associated with changes in the degree of TR. A large, prospective study is needed to accurately define the incidence and exact mechanisms of permanent endocardial lead-related TR.
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Masoud
authors: M
authors: Sadreddini
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Michelle J
authors: MJ
authors: Haroun
authors: Department of Medicine, University of Groningen, The Netherlands.
authors: Lisanne
authors: L
authors: Buikema
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Carlos
authors: C
authors: Morillo
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Sebastian
authors: S
authors: Ribas
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Syamkumar
authors: S
authors: Divakaramenon
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Stuart J
authors: SJ
authors: Connolly
authors: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors: Robby
authors: R
authors: Nieuwlaat
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Eva M
authors: EM
authors: Lonn
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Jeff S
authors: JS
authors: Healey
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Hisham
authors: H
authors: Dokainish
keywords: Cardiac resynchronization; echocardiography; implantable cardiac defibrillators; pacemakers; tricuspid regurgitation.