P6550Right ventricular apical pacing vs. non-right ventricular apical pacing induced tricuspid regurgitation: implication of 3D echocardiographic location of leads

Background

Pacemaker, device leads have been reported to cause tricuspid regurgitation (TR) of variable degrees. It is different between RVA pacing and None-RVA pacing in device-related TR. Few articles indicate this area. Objectives: We sought to evaluate (1) TR degree in patients with right ventricular apical (RVA) pacing vs. none-RVA pacing; (2) the relationship of lead-position between RVA vs. none-RVA pacing associated with TR undergo 3-dimensional echocardiography (3DE).

Methods

Conventional echocardiography performed in 458 patients after pacemaker implantation. In addition, 284 patients with pre-pacemaker implantation echocardiography available were included to evaluate the development of significant TR prospectively.

Results

RVA pacing patients had a higher frequency of significant TR (degree≥2) compared to none-RVA pacing (63% vs. 42%, p-value <0.01). For RVA pacing, the lead was more likely to position at the anterior, posterior and septal compared to none-RVA pacing (51% vs. 33%, p-value <0.01). Importantly, leads were more likely to be positioned in the central portion with none-RVA pacing compared to RVA pacing (30% vs. 13%, p-value <0.01). Among 284 patients with pre-& post-implantation echocardiography, RVA pacing is associated with the development of significant TR compared to none-RVA pacing (59% vs. 41%, P=0.012).

Factors Associated with Significant TR Univariate p-value Multivariate p-value Age 1.035 (1.016–1.055) <0.01 1.025 (1.005–1.047) 0.02 Duration 1.003 (1.001–1.006) 0.02 1.001 (0.998–1.004) 0.62 Male 0678 (0.468–0.980) 0.04 0.657 (0.436–0.991) 0.05 Pre-AF 2.623 (1.740–3.955) <0.01 1.162 (0.588–2.295) 0.67 Post-AF 3.529 (2.329–5.346) <0.01 2.671 (1.566–4.556) <0.01 DDDR 0.428 (0.236–0.777) 0.01 0.724 (0.336–1.563) 0.41 RVA 2.451 (1.673–3.589) <0.01 1.962 (1.266–3.042) <0.01

3D TTE view of the device leads in TVs

Conclusions

The study demonstrates that RVA pacing is more likely to develop significant TR compared to none-RVA pacing. Significantly, this study is the first details to demonstrate that lead impingement is one of the possible mechanisms that could explain the higher frequency of TR in RVA pacing compared to none-RVA pacing by 3DE.

Acknowledgement/Funding

This manuscript is partially supported by the Summit Grant from the University of Hong Kong and Queen Mary Hospital.