title: Tricuspid Regurgitation following Lead Extraction: Risk Factors and Clinical Course.
abstract: BACKGROUND
  Transvenous lead extraction can lead to tricuspid valve damage.
  
  
  OBJECTIVE
  To assess the incidence, risk factors and clinical outcome of tricuspid regurgitation (TR) following lead extraction.
  
  
  METHODS
  We prospectively collected data on patients who underwent lead extraction at the Sheba Medical Center prior to laser use (i.e., before 2012). Echocardiography results before and following the procedure were used to confirm TR worsening, defined as an echocardiographic increase of at least one TR grade. Various clinical and echocardiographic parameters were analyzed as risk factors for TR. Clinical and echocardiographic follow-up was conducted to assess the clinical significance outcome of extraction-induced TR.
  
  
  RESULTS
  Of 152 patients who underwent lead extraction without laser before 2012, 86 (56%) (192 electrodes) had echocardiography results before and within one week following the procedure. New or worsening TR was discovered in 13 patients (15%). Use of mechanical tools and younger age at extraction were found on multivariate analysis to be factors for TR development (P = 0.04 and P = 0.03 respectively). Average follow-up was 22.25 ± 21.34 months (range 8-93). There were no significant differences in the incidence of right-sided heart failure (50% vs. 23%, P = 0.192) or hospitalizations due to heart failure exacerbations (37.5% vs. 11%, P = 0.110). No patient required tricuspid valve repair or replacement. Death rates were similar in the TR and non-TR groups (20% vs. 33%).
  
  
  CONCLUSIONS
  TR following lead extraction is not uncommon but does not seem to affect survival or outcomes such as need for valve surgery. Its long-term effects remain to be determined.
authors.forename: Amir
authors.initials: A
authors.lastname: Givon
authors.forename: Natalia
authors.initials: N
authors.lastname: Vedernikova
authors.forename: David
authors.initials: D
authors.lastname: Luria
authors.forename: Ori
authors.initials: O
authors.lastname: Vatury
authors.forename: Rafael
authors.initials: R
authors.lastname: Kuperstein
authors.forename: Micha S
authors.initials: MS
authors.lastname: Feinberg
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: Eyal
authors.initials: E
authors.lastname: Nof
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000009:adverse effects*; D004452:Echocardiography; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology