P108 Clinical effect of tricuspid regurgitation caused by pacemaker lead

Aim It is known that the presence of cardiac pacemaker leads across the tricuspid valve (TV) can lead to tricuspid regurgitation (TR). However the clinical implications of this are not known. The aim of this study was to evaluate the progression of TR in patients with pacemaker leads across the TV and assess the clinical effect on Right ventricular function. Methods Patients who had undergone cardiac device implantation (either pacemaker or implantable cardiac defibrillators) in our institution over a 5 years period were identified. Those who had an echo (for any indication) pre and post device implantation were included in this study and their data assessed. Clinical information was obtained from medical records Results A total of 65 patients (mean age 70 + 13 years, 31 (48%) male and 34 (52%)female) were enrolled in the study. The median follow up after implantation was 12 (12-24) months. At baseline 29 patients had TR before implantation which increased to 51 (78%) during follow up, indicating that 22 patients developed new TR. Of those with pre existing TR, 17 had worsening of TR by at least one grade. RV function as measured by TAPSE had decreased from 1.87+ 0.44 to 1.68 +0.42 p = 0.002 . Six patients developed RV dilatation during follow up. 18 patients had developed signs of Right heart failure (either breathlessness with raised jugular venous pressure or pedal oedema or both), of which 13 had only new pedal oedema. There was no difference in comorbidities or the percentage of pacing in the groups that had worsening of TR or RV dilatation. Conclusion There is definite worsening or development of new TR in patients with a pacing lead across the TV. This is associated with an increase in the incidence of right heart failure suggesting that this is not benign. However there does not appear to be any specific risk factor identified that is responsible for this. Changes after pacemaker implantation Pre pacemaker Post pacemaker p value Presence of TR (n) 29 51 0.018 RV dilatation(n) 5 11 0.01 TAPSE (mm) 1.87 + 0.44 1.68 + 0.42 0.002 Presence of pedal oedema(n) 5 13 0.01 TR grade grade 0 Grade 1 Grade2 Grade 3 Grade 4 36 9 16 3 0 14 3 31 16 2 0.008 TR- tricuspid regurgition, TAPSE- Tricuspid annular plane systolic excursion; RV- right ventricle