Introduction:
Right ventricular (RV) leads of permanent pacemakers (PM) contribute or cause tricuspid regurgitation (TR) in up to 45% of implantations, which is associated with poor outcome. While primary lead-induced TR has its origin in direct interaction of the lead and the valve, secondary lead-induced TR has its origin in RV dilatation (RVD).
Hypothesis:
We hypothesize differences in lead-induced TR and its associated mortality comparing patients with vs. without RVD.
Methods:
Patients with first implantation of a cardiac PM with at least one transtricuspid RV-lead between May 2000 and April 2015 were retrospectively included. Echo was performed before and after PM implantation.
Results:
In total, 990 patients were enrolled (Table 1). Patients with RVD had progression of TR of at least one grade in 50.2%, compared to 35.9% in patients without RVD (p<0.001). In a multivariate regression model, independent predictors for lead-induced progression of TR were RVD (OR 1.46, 95% CI 1.01-2.12, p=0.045), and moderate/severe mitral regurgitation (OR 1.51, 95%CI 1.12-2.02, p=0.006). Independent predictors for 10-year-mortality were lead-induced progression of TR (HR 1.36, 95%CI 1.04-1.78, p=0.023), age > 80 years (HR 2.78, 95%CI 2.14-3.61, p<0.001), PM with single RV-lead (HR 1.35, 95%CI 1.03-1.77, p=0.032), heart failure (HR 1.75, 95%CI 1.32-2.32, p<0.001), chronic kidney disease (HR 1.61, 95%CI 1.24-2.09, p<0.001), moderate/severe mitral regurgitation (HR 1.31, 95%CI 1.03-1.74, p=0.031), and LVEDD > 25mm/m2 (HR 1.37, 95%CI 1.06-1.77, p=0.015).
Conclusions:
RVD is associated with lead-induced progression of TR, which is associated with decreased survival. Patients with RVD and indication for a PM, leadless pacing could be an alternative. If lead-induced TR occurs, transcatheter tricuspid valve intervention is a possibility, especially in patients with RVD.
B-PO03-056 CULPRIT, BYSTANDER, OR A HOLE OTHER MATTER: ENDOCARDIAL LV PACEMAKER LEAD EXTRACTION FOR SEVERE MITRAL REGURGITATION
