Prevention of Pacemaker Lead-Induced Tricuspid Regurgitation by Transesophageal Echocardiography Guided Implantation

2021 ◽  
Vol 14 (23) ◽  
pp. 2636-2638
Author(s):  
Jonas Gmeiner ◽  
Sebastian Sadoni ◽  
Mathias Orban ◽  
Stephanie Fichtner ◽  
Heidi Estner ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Tricuspid Regurgitation ◽  
Pacemaker Lead

scholarly journals Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

2021 ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Marianne Gwechenberger ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Ventricular Dilatation ◽  
Pacemaker Lead ◽  
Survival Analyses ◽  
Before And After ◽  
Right Ventricular Dilatation ◽  
Survival Predictors

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

scholarly journals Case report: Pacemaker lead perforation of a papillary muscle inducing severe tricuspid regurgitation

2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Martin Andreas ◽  
Franz Gremmel ◽  
Andreas Habertheuer ◽  
Claus Rath ◽  
Claudia Oeser ◽  
...  
Keyword(s):  
Case Report ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Pacemaker Lead ◽  
Severe Tricuspid Regurgitation ◽  
Lead Perforation

Abstract 15817: Tricuspid Valve Imaging by 3D Transesophageal Echocardiography: Feasibility of Coaptation Length Measurement and Its Relationship With Severity of Regurgitation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kikuko Obase ◽  
Lynn Weinert ◽  
Victor Mor-Avi ◽  
Roberto M Lang
Keyword(s):  
Transesophageal Echocardiography ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
The Other ◽  
Tricuspid Valve Repair ◽  
Mitral Valve Leaflet ◽  
2D Echocardiography ◽  
3D Transesophageal Echocardiography ◽  
Leaflet Coaptation

Background: The coaptation length (CL) of the mitral valve leaflet decreases with increasing mitral regurgitation. Visualization of the CL of the tricuspid valve (TV) is challenging using conventional 2D echocardiography. The aims of this study were: (1) to test the feasibility of visualizing and quantifying the CL of the TV using three-dimensional (3D) transesophageal echocardiography (TEE), and (2) to study it relationship with the severity of tricuspid regurgitation (TR). Methods: Full-volume 3D TEE datasets of the TV were obtained in 24 patients from the transgastric approach. Using multiplanar reconstruction, short-axis plane depicting an en-face view of the TV was used to mark the central coaptation point (Fig. A). Three planes cutting through this point were then selected to view the 3 coaptation lines between: (1) anterior and posterior, (2) septal and anterior, and (3) septal and posterior TV leaflets (Figs. B-D). The CL was measured in each of these planes to obtain mean CL. The severity of tricuspid regurgitation was graded qualitatively as “none”, “trace”, “mild” and “moderate”. Results: Visualization of leaflet coaptation was feasible in 17/24 patients (71%). The mean CL was 0.89±0.03 cm in patients with no TR (N=4), 0.64±0.13 with trace TR (N=6), 0.50±0.07 with mild TR (N=3) and 0.13±0.11 with moderate TR (N=4). Since there was no overlap between the “moderate” group and the other 3 groups, the threshold of average CL for moderate TR was estimated to be between 0.25 (highest value in the “moderate” group) and 0.39 cm (lowest value in the other groups) (Fig. E). Conclusion: Visualization of the TV leaflet coaptation length from transgastric 3D TEE images is feasible in the majority of patients. TV coaptation length is inversely related to the severity of TR. The ability to visualize and quantify the CL of the TV may be useful when planning tricuspid valve repair surgery. Our findings suggest that CL below the threshold may indicate clinically significant TR.

Pacemaker lead-induced progression of primary vs. secondary tricuspid regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Riesenhuber ◽  
A Spannbauer ◽  
T Pezawas ◽  
C Schukro ◽  
M Gwechenberger ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Patient Characteristics ◽  
Funding Source ◽  
Pacemaker Lead ◽  
Horizon 2020 ◽  
Ordinal Regression Model ◽  
Leadless Pacing ◽  
Public Grant ◽  
Visually Based ◽  
Programme Grant

Abstract Background Currently no data are available whether the implantation of right ventricular (RV) pacemaker (PM) lead worsens preexisting primary or secondary (functional due to RV dilatation, RVD) tricuspid regurgitation (TR). Purpose The aim of the present retrospective analysis was to assess TR after PM implantation with a RV lead. Methods Patients with PM implantation (n=990) were enrolled if they had routine echocardiography including assessment of TR before first implantation and immediately after. RVD and severity of TR were characterized visually. Based on RVD in baseline echocardiography, patients were divided into 2 groups: with primary TR (without preexisting RVD, n=743) or secondary TR (with preexisting RVD, n=243). Results Lead-induced worsening of TR was present in both groups (Table 1). Progression from mild/moderate to severe TR was observed in 6.7% of patients with primary TR, compared to 25.6% of patients with secondary TR (P=0.001). Using an ordinal regression model, the probability to progress to severe TR with primary TR was 14.8% (95% CI 11.0%-19.7%), compared to 41.6% (95% CI 40.3%-42.8%) with secondary TR (P&lt;0.001). Conclusion Preexisting secondary TR was associated with higher rates of lead-induced progression to severe TR compared to primary TR. Leadless pacing or tricuspid valve clipping post-PM implantation could be an option for patients with preexisting secondary TR and indication for a PM. Table 1. Patient characteristics. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): This study was supported by the European Union's Horizon 2020 Future and Emerging Technologies Programme [Grant number 732170].

Traumatic tricuspid regurgitation with cyanosis: Diagnosis by transesophageal echocardiography

1996 ◽  
Vol 61 (3) ◽  
pp. 992-993 ◽  
Author(s):  
William C. Chiu ◽  
Daniel M. Shindler ◽  
Peter M. Scholz ◽  
Andrew H. Boyarsky
Keyword(s):  
Transesophageal Echocardiography ◽  
Tricuspid Regurgitation ◽  
Traumatic Tricuspid Regurgitation

An unexpected complication during percutaneous pacemaker lead extraction unveiled by transesophageal echocardiography

2014 ◽  
Vol 177 (3) ◽  
pp. e125-e127 ◽  
Author(s):  
Skevos Sideris ◽  
Georgios Benetos ◽  
George Lazaros ◽  
Konstantinos Gatzoulis ◽  
Dimitris Lymperiadis ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Lead Extraction ◽  
Pacemaker Lead

Abstract 12929: Pacemaker Lead-induced Tricuspid Regurgitation in Patients With or Without RV Dilatation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
Marianne Gwechenberger ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Multivariate Regression ◽  
Direct Interaction ◽  
Severe Mitral Regurgitation ◽  
Pacemaker Lead ◽  
Multivariate Regression Model ◽  
Before And After ◽  
Leadless Pacing ◽  
Model Independent

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.

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