PT  - JOURNAL ARTICLE
AU  - Ulas Höke
AU  - Dominique Auger
AU  - Joep Thijssen
AU  - Ron Wolterbeek
AU  - Enno T van der Velde
AU  - Eduard R Holman
AU  - Martin J Schalij
AU  - Jeroen J Bax
AU  - Victoria Delgado
AU  - Nina Ajmone Marsan
TI  - Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up
AID  - 10.1136/heartjnl-2013-304673
DP  - 2014 Jun 15
TA  - Heart
PG  - 960--968
VI  - 100
IP  - 12
4099  - http://heart.bmj.com/content/100/12/960.short
4100  - http://heart.bmj.com/content/100/12/960.full
SO  - Heart2014 Jun 15; 100
AB  - 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.