The Effect of Transvenous Pacemaker and Implantable Cardioverter Defibrillator Lead Placement on Tricuspid Valve Function: An Observational Study

doi:10.1016/j.echo.2007.05.022

Journal of the American Society of Echocardiography

Volume 21, Issue 3, March 2008, Pages 284-287

https://doi.org/10.1016/j.echo.2007.05.022 Get rights and content

This study assessed the effect of transtricuspid placement of permanent pacemaker (PPM) and implantable cardioverter defibrillator (ICD) leads on tricuspid regurgitation (TR) in 248 patients with echocardiograms before and after placement. Some 21.2% of patients with baseline mild TR or less developed abnormal TR (3.4% mild-moderate, 12.8% moderate, 1.1% moderate-severe, 3.9% severe) after implant. TR worsened by 1 grade or more after implant in 24.2% (20.7% of PPMs vs. 32.4% of ICDs; P < .05). TR worsening was more common with ICDs than PPMs in patients with baseline mild TR or less. After lead implantation, abnormal TR developed in 21.2% and severe TR developed in 3.9% of patients with initially normal TR. TR worsened by at least 1 grade in 24.2%. Patients with ICDs had a higher rate of TR worsening compared with patients with PPMs (32.4% vs. 20.1%; P < .05).

Section snippets

Population

All patients who underwent placement of a transvenous permanent pacemaker (PPM) or ICD lead at our electrophysiology laboratory between January 1, 2000, and April 30, 2005, were considered for inclusion. Lead replacement procedures were not considered. Patients were included in the study if echocardiography data were available within 1 year before and after lead insertion. There were no other exclusion criteria. The study was approved by the New York University School of Medicine Institutional

Results

Pre- and postimplant echocardiograms were available for 248 patients (174 with PPM, 74 with ICD) who had a transvenous lead implanted at our institution within the defined time window.

The baseline characteristics of the study population are described in Table 1. The mean age of the population was 75.4 ± 13.4 years, and 59% were men. The median time from preimplantation echocardiogram to implantation was 7 days; the median time from implantation to postimplantation echocardiogram was 93 days.

Discussion

This study showed that worsening of TR associated with the implantation of transvenous pacemaker or ICD leads is common. Twenty-one percent of all patients with mild TR or less developed significant TR after the implantation in our study, including 5% who developed moderate-to-severe or severe TR. There was a statistically significant increase in the level of TR when all patients were considered.

It is noteworthy that a greater proportion of subjects with ICD implant had significant worsening of

Conclusion

Worsening of TR is common after transvenous lead placement and is more common after ICD than PPM insertion.

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Clinical investigationFunctional effects of pacingThe Effect of Transvenous Pacemaker and Implantable Cardioverter Defibrillator Lead Placement on Tricuspid Valve Function: An Observational Study

Section snippets

Population

Results

Discussion

Conclusion

Am Heart J

Chest

J Am Soc Echocardiogr

Chest

Chest

Int J Cardiol

Am J Cardiol

J Am Coll Cardiol

Clinical investigation
Functional effects of pacing
The Effect of Transvenous Pacemaker and Implantable Cardioverter Defibrillator Lead Placement on Tricuspid Valve Function: An Observational Study