Effects of pacemaker and implantable cardioverter defibrillator electrodes on tricuspid regurgitation and right sided heart functions

Abstract

Background: The aim of this study was to assess the effect of trans-tricuspid placement of permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) leads prospectively on tricuspid valve and right-sided heart functions using two-dimensional echocardiography. Methods: A total of 41 patients (31 male, mean age: 63.6 ± 12.2 years) were included in this prospective study. Initial echocardiographic evaluation was performed before cardiac device implantation and re-evaluation by echocardiography was performed immediately after the procedure and at 1st, 6th and 12th months. In addition to standard echocardiographic examinations, vena contracta (VC), proximal isovelocity surface area (PISA), and tissue Doppler evaluations were also performed in the study population. Results: Tricuspid regurgitation (TR) is worsened by 1 grade in 70.8% of the patients and 2 grades in 17.1% of the patients in the follow-up. Eight patients without baseline TR developed new-onset TR (9.8% mild, 9.8% moderate) after lead implantation. In the follow-up period, 41.5% of the patients who had mild TR before lead implantation developed moderate TR and 7.3% developed severe TR, whereas 19.5% of the patients with moderate TR developed severe TR during the follow-up. In the follow-up period, VC of TR was increased [median: 0.32 (0.16–0.60) cm in pre-implantation period, and 0.41 (0.18–0.80) cm at 12th month, p = 0.001]. Similarly PISA value of TR was also increased [median: 0.46 (0.15–1.10) cm in pre-implantation period and 0.52 (0.28–1.20) cm at 12th month, p = 0.001]. However, there is not a significant difference between PPMs/ICDs and CRTs regarding the effects on TR (p < 0.05). In addition, right ventricular dimensions and right atrial volumes were increased during the follow-up. Conclusions: Implantation of permanent transvenous right ventricular electrode is associated with worsening of TR, right atrial and right ventricular dimensions. Further studies are needed in order to both outline the effect of those findings on outcomes and clarify the time dependent changes in those functions.