Tricuspid Regurgitation Following Implantation of Endocardial Leads: Incidence and Predictors

Autor:	Regina C. Lee, Mark L. Greenberg, Alan T. Kono, Scott E. Friedman, Robert T. Palac
Rok vydání:	2015
Předmět:	medicine.medical_specialty Mitral regurgitation Tricuspid valve business.industry medicine.medical_treatment Atrial fibrillation General Medicine medicine.disease Implantable cardioverter-defibrillator medicine.anatomical_structure Tricuspid Valve Insufficiency Internal medicine Predictive value of tests medicine Cardiology Cardiology and Cardiovascular Medicine Lead Placement business Complication
Zdroj:	Pacing and Clinical Electrophysiology. 38:1267-1274
ISSN:	0147-8389
DOI:	10.1111/pace.12701
Popis:	Background Endocardial leads, permanent pacemaker (PPM), or implantable cardioverter defibrillator (ICD) placed across the tricuspid valve can lead to tricuspid regurgitation (TR). The reported incidence of this complication has varied widely. There are limited data predicting which patients will develop this complication. This study sought to describe the incidence of worsening TR post-PPM or ICD and to identify patient-specific predictors of increased TR following lead placement. Methods Patients (N = 382) who received a PPM or ICD from January 1, 2006 to December 31, 2010 and had echocardiograms both within 365 days prior to and up to 1,200 days after device placement were studied. TR was assessed on a 6-point scale (none/trace, mild, mild to moderate, moderate, moderate to severe, severe). Primary outcome was a two-grade increase in the severity of TR. Echocardiographic and clinical predictors of worsening TR were examined using multivariate regression. Results A two-grade increase in TR occurred in 10.0% of our patient population. Age, lead position, atrial fibrillation, right atrial (RA) area, right ventricular systolic pressure (RVSP), left atrial area, and severity of mitral regurgitation were univariate predictors of worsening TR post lead placement. In the multivariate analysis, predevice RA area and RVSP were associated with increased TR after endocardial lead placement. Percentage of time spent pacing did not appear to be associated with increased TR. Conclusion The incidence of increased TR postendocardial lead placement was 10.0%; this is lower than prior estimates. Predevice RA area and RVSP are predictors of increased TR after lead placement.
Databáze:	OpenAIRE
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