title: Tricuspid Regurgitation Following Implantation of Endocardial Leads: Incidence and Predictors.
abstract: BACKGROUND
  Endocardial leads, permanent pacemaker (PPM), or implantable cardioverter defibrillator (ICD) placed across the tricuspid valve can lead to tricuspid regurgitation (TR). The reported incidence of this complication has varied widely. There are limited data predicting which patients will develop this complication. This study sought to describe the incidence of worsening TR post-PPM or ICD and to identify patient-specific predictors of increased TR following lead placement.
  
  
  METHODS
  Patients (N = 382) who received a PPM or ICD from January 1, 2006 to December 31, 2010 and had echocardiograms both within 365 days prior to and up to 1,200 days after device placement were studied. TR was assessed on a 6-point scale (none/trace, mild, mild to moderate, moderate, moderate to severe, severe). Primary outcome was a two-grade increase in the severity of TR. Echocardiographic and clinical predictors of worsening TR were examined using multivariate regression.
  
  
  RESULTS
  A two-grade increase in TR occurred in 10.0% of our patient population. Age, lead position, atrial fibrillation, right atrial (RA) area, right ventricular systolic pressure (RVSP), left atrial area, and severity of mitral regurgitation were univariate predictors of worsening TR post lead placement. In the multivariate analysis, predevice RA area and RVSP were associated with increased TR after endocardial lead placement. Percentage of time spent pacing did not appear to be associated with increased TR.
  
  
  CONCLUSIONS
  The incidence of increased TR postendocardial lead placement was 10.0%; this is lower than prior estimates. Predevice RA area and RVSP are predictors of increased TR after lead placement.
authors.affiliation: Department of Cardiology, Georgetown Medical Center, Washington, DC.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Lee
authors.affiliation: Department of Cardiology, White River Junction VA, White River, Vermont.|Department of Cardiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Friedman
authors.affiliation: Department of Cardiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Kono
authors.affiliation: Department of Cardiology, White River Junction VA, White River, Vermont.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
authors.affiliation: Department of Cardiology, Georgetown Medical Center, Washington, DC.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Palac
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004699:Endocardium; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011237:Predictive Value of Tests; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D014463:Ultrasonography
keywords: endocardial lead; pacemaker; tricuspid regurgitation