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Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up
  1. Ulas Höke1,2,
  2. Dominique Auger1,
  3. Joep Thijssen1,
  4. Ron Wolterbeek3,
  5. Enno T van der Velde1,
  6. Eduard R Holman1,
  7. Martin J Schalij1,
  8. Jeroen J Bax1,
  9. Victoria Delgado1,
  10. Nina Ajmone Marsan1
  1. 1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
  3. 3Department of Biostatistics, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Dr Nina Ajmone Marsan, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, The Netherlands; N.Ajmone{at}


Background Although the presence of an RV lead is a potential cause of tricuspid regurgitation (TR), the clinical impact of significant lead-induced TR is unknown.

Objective To evaluate the effect of significant lead-induced TR on cardiac performance and long-term outcome after cardioverter-defibrillator (ICD) or pacemaker implantation.

Methods A retrospective cohort of 239 ICD (n=191) or pacemaker (n=48) recipients (age 60±14 years, 77% male) from a tertiary care university hospital, with an echocardiographic evaluation before and within 1–1.5 years after device implantation were included. Significant lead-induced TR was defined as TR worsening, reaching a grade ≥2 at follow-up echocardiography. During long-term follow-up (median 58, IQR 35–76 months), all-cause mortality and heart failure related events were recorded.

Results Before device implantation, most patients had TR grade 1 or 2 (64.0%) or no TR (33.9%), but after lead placement, significant TR was seen in 91 patients (38%). Changes in cardiac volumes and function at follow-up were similar between patients with and without significant lead-induced TR, except for larger RV diastolic area (17±6mm2 vs 16±5mm2, p=0.009), larger right atrial diameter (39±10 mm vs 36±8 mm, p<0.001) and higher pulmonary arterial pressures (41±15 mm Hg vs 33±10 mm Hg, p<0.001) in patients with significant lead-induced TR. Patients with significant lead-induced TR had worse long-term survival (HR=1.687, p=0.040) and/or more heart failure related events (HR=1.641, p=0.019). At multivariate analysis, significant lead-induced TR was independently associated with all-cause mortality (HR=1.749, p=0.047) together with age, LVEF and percentage RV pacing.

Conclusions Significant lead-induced TR is associated with poor long-term prognosis.


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