Echocardiography-guided Cardiac Implantable Electronic Device Implantation to Reduce Device Related Tricuspid Regurgitation: A Prospective Controlled Study

Gergana Marincheva, Tal Levi, Olga Perelshtein Brezinov, Andrei Valdman, Michael Rahkovich, Yonatan Kogan, Avishag Laish-Farkash

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Endocardial leads of permanent pacemakers (PPM) and implantable defibrillators (ICD) across the tricuspid valve (TV) can lead to tricuspid regurgitation (TR) or can worsen existing TR with subsequent severe morbidity and mortality. Objectives: To evaluate prospectively the efficacy of intraproce-dural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR. Methods: We conducted a prospective randomized controlled study comparing echocardiography results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55). Lead position was changed if TR grade was more than baseline in Group 1. Cohort patients underwent 2DTTE at baseline and 3 and/or 6 months after implantation. Excluded were patients with baseline TR > moderate or baseline ≥ moderate RV dysfunction. Results: The study comprised 111 patients (74.14 ± 11 years of age, 58.6% male, 19% ICD, 42% active leads). In 98 patients there was at least one follow-up echo. Two patients from Group 1 (3.6%) needed intraprocedural RV electrode repositioning. Four patients (3.5%, 2 from each group, all dual chamber PPM, 3 atrial fibrillation, 2 RV pacing > 40%, none with intraprocedural reposition) had TR deterioration during 6 months follow-up. One patient from Group 2 with baseline mild-moderate aortic regurgitation (AR) had worsening TR and AR within 3 months and underwent aortic valve replacement and TV repair. Conclusions: The rate of mechanically induced lead-associated TR is low; thus, a routine intraprocedural 2DTTE does not have a significant role in reducing/preventing it.

    Original languageEnglish
    Pages (from-to)25-32
    Number of pages8
    JournalIsrael Medical Association Journal
    Volume24
    Issue number1
    StatePublished - 1 Jan 2022

    Keywords

    • defibrillator
    • echocardiography
    • implantation
    • pacemaker
    • tricuspid regurgitation

    ASJC Scopus subject areas

    • Medicine (all)

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