title: The effects of right ventricular apical pacing with transvenous pacemaker and implantable cardioverter defibrillator on mitral and tricuspid regurgitation.
abstract: BACKGROUND
  The incidence of new or worsening tricuspid regurgitation (TR) or mitral regurgitation (MR) after permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) lead placement has not been well investigated. We studied the effect of transvenous leads implantation and right ventricular (RV) pacing on tricuspid and mitral valve regurgitations.
  
  
  METHODS
  We reviewed the charts of all patients undergoing PPM or ICD lead placement in our electrophysiology laboratory from December 2001 to December 2006.
  
  
  RESULTS
  A total of 206 patients (120 with PPM and 86 with ICD) had baseline echocardiography within 6months before, and a follow up study at least 6months after lead insertion. The mean age was 74±14years; 56% were men. The follow-up period was 29±19months. TR worsened by at least one grade after lead insertion in 44.7% patients (P<0.001). Pre- and post-implant changes in TR severity did not differ with respect to lead type (ICD vs. PPM) or degree of RV pacing dependence. As for MR; patients with high frequency of RV pacing (>40%) had a higher incidence of worsening MR when compared to those with low frequency of RV pacing (44% vs. 19%; P<0.001).
  
  
  CONCLUSIONS
  PPM or ICD lead implantation worsens TR; that effect is probably induced by mechanical interferences with the TV closure and was consistent regardless the lead type or degree of RV Pacing. MR was noted to increase in patients with high frequency of RV pacing frequency; this is probably caused by the mechanical dyssynchrony induced by RV pacing.
authors.affiliation: Section of Cardiology, Christiana Care Health System, Newark, DE, USA. Electronic address: zfanari@christianacare.org.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Fanari
authors.affiliation: Section of Cardiology, Christiana Care Health System, Newark, DE, USA.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Hammami
authors.affiliation: Section of Cardiology, Christiana Care Health System, Newark, DE, USA.
authors.forename: Muhammad Baraa
authors.initials: MB
authors.lastname: Hammami
authors.affiliation: Section of Cardiology, Christiana Care Health System, Newark, DE, USA.
authors.forename: Safa
authors.initials: S
authors.lastname: Hammami
authors.affiliation: Texas Heart Institute, Houston, TX, USA.
authors.forename: Mossaab
authors.initials: M
authors.lastname: Shuraih
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D003691:Delaware / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008944:Mitral Valve Insufficiency / Q000453:epidemiology* / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Implantable cardioverter defibrillator; Mitral regurgitation; Permanent pacemaker; Right ventricular pacing; Tricuspid regurgitation