Assessment of the effects of cardiac rhythm device implantation on right sided heart function and tricuspid valve

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Abd Elaziz ◽  
Ahmed Yehia Ramadan ◽  
Haitham Abd Elfatah Badran ◽  
Saied Abd Elhafiz Khalid
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Cardiac Rhythm ◽  
Heart Function ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
P Value ◽  
Device Implantation ◽  
Echocardiographic Study ◽  
One Year

Abstract Objective To assess the effects of trans-tricuspid placement of permanent pacemaker (PPM), on the right-sided heart function and tricuspid valve function. Background Over the last decade there has been a significant increase in the number of cardiac device implantation as permanent pacemakers (PPM) worldwide in patients with cardiac rhythm disorders. Tricuspid regurgitation (TR) due to the endocardial lead is a known complication of this procedure, however the incidence of new or worsening TR had not been well studied. Patients and Methods We reviewed patients who underwent permanent pacemaker implantation in our cardiology department in Ain Shams University. Patients who had pacemaker implantation less than one year ago, had severe tricuspid regurgitation before implantation or had previous tricuspid valve repair were excluded. A total of one hundred patients with an echocardiographic study before and another echocardiographic study at least one year after device implantation were included in our study. TR severity was graded as (0 none/trace, 1 mild, 2 moderate, 3 severe). Results Of the 100 patients (Mean age: 53.10 ± 16.04, 50% of patients were males) 65 had DDD and 35 had VVI. Before implantation 25 patient had trace TR (grade 0) vs. 6 patients after, 75 patients had mild TR (grade 1) vs. 82 after, with no patient had moderate TR (grade 2) vs. 12 patients after. TR worsened by one grade in 25 patients, (16 patients from grade 0 to grade 1 and 9 patients from grade 1 to grade 2) and by 2 grades in 3 patients (from grade 0 to grade 2), Pvalue < 0.01. TR jet area size (Mean ± SD: 2.80 ± 0.77 before vs. 4.15 ± 1.29 after, P-value < 0.01). Also, 99 patients had normal RV size and one had dilated RV before implantation vs. 95 patient had normal RV and 5 had dilated RV (p-value= 0.097). RV size, LVEF (Mean ± SD: 56.41% ± 7.52 before vs. 55.77% ± 8.00 after), RV function by TASPE (Mean ± SD: 19.15 ± 1.00 before vs. 18.96 ± 0.96 after), RVSP (Mean ± SD: 29.48mmHg ± 5.54 before vs. 29.81 ± 5.09 after) and diastolic function by E/A ratio (Mean ± SD: 1.60 ± 0.39 before vs. 1.57 ± 0.38 after implantation) did not show significant change. Conclusion Permanent pacemaker (PPM) implantation is associated with worsening of tricuspid regurgitation. Echocardiography plays an important role in assessing and grading this condition. Further studies are needed in order to illustrate the effects of these finding on patients outcomes.

Genesis of tricuspid regurgitation after permanent pacemaker implantation: two-dimensional and M-mode echocardiographic study

Choonpa Igaku ◽  
2011 ◽  
Vol 38 (2) ◽  
pp. 111-117
Author(s):  
Sayuki KOBAYASHI ◽  
Terumi HAYASHI ◽  
Michiko MINAI ◽  
Hiroko ZENRI ◽  
Michiko ICHIHARA ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Two Dimensional ◽  
Permanent Pacemaker Implantation ◽  
Echocardiographic Study

scholarly journals Comparative early outcomes of tricuspid Valve repair versus replacement for secondary tricuspid regurgitation

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000878 ◽  
Author(s):  
Mohamad Alkhouli ◽  
Chalak Berzingi ◽  
Amer Kowatli ◽  
Fahad Alqahtani ◽  
Vinay Badhwar
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Permanent Pacemaker Implantation

BackgroundComparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited.MethodsWe used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR.ResultsA total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, which were more common in the TVR group. Before propensity matching, in-hospital mortality was similar between patients who underwent isolated TVr and TVR (8.1% vs 10.8%, p=0.093), but the incidence of postoperative morbidities differed: TVR was associated with higher rates of permanent pacemaker implantation and blood transfusion, while TVr was associated with more acute kidney injury. After rigorous propensity score matching, TVR was associated with significantly higher rates of in-hospital death (12% vs 6.9%, p=0.009) and permanent pacemaker implantation (33.7% vs 11.2%, p<0.001). Postoperative morbidities and length of stay, however, were not different between the two groups. Nonetheless, cost of hospitalisation was 16% higher in the TVr group.ConclusionsIn patients undergoing isolated surgery for secondary TR, TVR is associated with higher in-hospital mortality and need for permanent pacemaker compared with TVr. Further studies are needed to understand the impact of the type of surgery on the short-term and long-term mortality in this complex undertreated population.

scholarly journals Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0235230
Author(s):  
Jiwon Seo ◽  
Dae-Young Kim ◽  
Iksung Cho ◽  
Geu-Ru Hong ◽  
Jong-Won Ha ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation

scholarly journals P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Moscatelli ◽  
G Trocchio ◽  
N Stagnaro ◽  
A Siboldi ◽  
M Derchi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Atrial Flutter ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Rare Condition ◽  
Systolic Pulmonary Artery Pressure ◽  
Severe Tricuspid Regurgitation ◽  
One Year ◽  
The Right

Abstract Introduction Tricuspid valve duplication is an extremely rare condition and in most of the cases it is associated with other congenital cardiac malformations. Because of its rarity, the clinical presentation and the management are not defined yet. Clinical Case We report the case of an 18 y/o caucasian male, who was admitted to our Hospital in February 2018 for rapid atrial flutter not responsive to medical therapy (propanolol and digossin). He had a pre-natal diagnose of ventricular septum defect (VSD) and tricuspid straddling. At 1 year of age he underwent pulmonary artery bandage and one year later VSD closure was performed. Blood test showed sub-clinic hypothyroidism, probably related to previous amiodaron therapy. A transthoracic echocardiogram was obtained. The right atrium (RA) was severely dilated and the atrial septum dislocated towards left ventricle (LV); two right atrioventricular valves (tricuspid valves) were detected: the ‘true’ tricuspid opening was inside the right ventricle, and an ‘accessory‘ opening was located inside the LV and severely regurgitant into the RA; the mitral valve was morphologically and functionally normal; both ventricles were dilated with preserved systolic function; systolic pulmonary artery pressure was not detectable. A Cardiac Magnetic Resonance clearly delineated the anomaly. Atrial flutter radio frequency transcatheter ablation was succesfully performed before corrective surgery. The regurgitant accessory tricuspid orifice was closed with an heterologous pericardial patch and a right reduction atrioplasty was also done. The post-operative course was uneventful and only a mild paraseptal tricuspid jet with LV to RA shunt was present at post op echocardiography. After one year follow-up the patient remained asymptomatic, without arrhythmia recurrence. Conclusion DOTV is an extremely rare condition that could be responsible of severe tricuspid regurgitation. At the moment, there are not sufficient data to establish the correct timing for surgical intervention. In our case, the presence of severe tricuspid regurgitation, right atrium dilatation, biventricular overload and atrial flutter guided the clinical management and suggested surgical correction. Abstract P189 Figure.

scholarly journals DEVELOPMENT AND PROGRESSION OF TRICUSPID REGURGITATION FOLLOWING PERMANENT PACEMAKER IMPLANTATION AFTER TAVR

2020 ◽  
Vol 75 (11) ◽  
pp. 2144
Author(s):  
Mohanad Hamandi ◽  
Johanna Van Zyl ◽  
Russana Thomas ◽  
Necole Kell ◽  
Anna Sannino ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation

scholarly journals Trends and Profile of Permanent Pacemaker Implantation in Nepal. Experience From Tertiary Cardiac Center (SGNHC) From 2001 to 2020.

2021 ◽  
Vol 18 (1) ◽  
pp. 29-32
Author(s):  
Murari Dhungana ◽  
Kunjang Sherpa ◽  
Roshan Raut ◽  
Surakchhya Joshi ◽  
Prashant Bajracharya ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Early Years ◽  
P Value ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Single Chamber ◽  
Common Indication ◽  
Permanent Pacemaker Implantation ◽  
Cardiac Center

Background and Aims: The number of pacemaker implantation is increasing at various centres of Nepal with increase in cardiac services. However, there are few data available regarding the pacemaker implantation in Nepal. This study intend to focus and study trends and profile of permanent pacemaker implantation (PPI) of 19 years experience at the referral tertiary cardiac center which will reflect intended objective of this study. Methods: This was a retrospective cross sectional study done at Shahid Gangalal National Heart Centre (SGNHC). The data of the patient who underwent PPI from 2001 November to 2020 August were reviewed. Patients data including age, sex, indication for pacing, mode of pacing, type of pacemaker implanted, implantation parameters such as lead impedence and threshold were recorded and analyzed. Results: A total of 3631 pacemaker implantation were performed at SGNHC from 2001 November to 2020 August. Among the total patients, 59.4% were male with mean age of 65.2±15.2 years. The most common indication was degenerative complete heart block (74.8%). Sick sinus syndrome (8.2%) was the second most common indication of pacing. The single chamber were implanted in 93.3% cases and dual chamber in 6.7% cases. VVIR was the most common mode of implantation in 93.1% cases, followed by DDDR (6.7%). AAIR (0.1%) and VDD in 0.1% cases. The total number of pacemaker implanted yearly in SGNHC has increased since the early year of implantation. During the early years most of the pacemakers were Single chamber (VVI) pacemaker and the implantation of dual chamber pacemaker increased gradually from year 2010 onwards. After the year 2010 the implantation of dual chamber pacemaker has increased significantly compared to prior to 2010 (p= 0.001). There were no gender differences in use of single chamber and dual chamber implantation during this period. (p value = 0.489). The dual chamber were implanted mostly in age group less than 65 year compared to more than 65 years (P value = 0.001). Conclusion: There is gradual increase in the number of pacemaker implantation yearly at SGNHC and since 2010 there is also increase in number of dual chamber pacemaker implantation though the single chamber pacemaker outnumbered the dual chamber implantation.

scholarly journals Predictors of the Development of Significant Tricuspid Regurgitation after Permanent Pacemaker Implantation

2014 ◽  
Vol 86 (5) ◽  
pp. 577 ◽  
Author(s):  
Kyoung Jin Lee ◽  
Kye Hun Kim ◽  
Yi Rang Yim ◽  
Hyuk Jin Park ◽  
Seung Hun Lee ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation

No impact of direct implantation of a self-expanding valve on one-year clinical outcomes. Insights from the multicenter, randomized DIRECT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Toutouzas ◽  
G Benetos ◽  
M Drakopoulou ◽  
M Karmpalioti ◽  
M Xanthopoulou ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiac Death ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Funding Source ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Introduction The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) evaluated in a randomized fashion the safety and efficacy of direct (without balloon pre-dilatation) implantation of a self-expanding valve in all comers undergoing TAVI. Purpose To investigate the impact of direct implantation of a self-expanding valve on one-year clinical outcomes. Methods DIRECT trial randomized consecutive patients with severe aortic stenosis at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). The primary endpoint was device success according to the VARC-2 criteria. Secondary endpoints included periprocedural mortality and stroke, new permanent pacemaker implantation and vascular complications. All cause death, cardiac death, stroke and heart failure hospitalizations were recorded at one year and compared between the two groups using Kaplan-Meier plots. Results In total 171 patients were randomized in 4 centers. In the intention to treat analysis 86 patients were randomized to the pre-BAV group and 85 patients to the no-BAV TAVI group. The device success according to the VARC-2 criteria was non-inferior in the no-BAV group compared to the pre-BAV group (65/85 - 76.5% for no-BAV versus 64/86 – 74.4% for pre-BAV, mean difference = 2.1%, 90% CI: −8.9 to 13). In the no-BAV group 25 (29.4%) patients underwent post balloon dilatation and in the pre-BAV group 13 patients (15.1%) (p=0.03). At one year 4 deaths were recorded in pre-BAV group (4.7%) and 3 deaths in no-BAV group (3.5%). There was no difference in Kaplan-Meier plots between the two groups in all-cause mortality (log-rank p=0.72, figure). Similarly, there was no difference in one-year incidence of stroke (1 in pre-BAV and 2 in no-BAV group, log-rank p=0.55), cardiac death (log-rank p=0.66), non-cardiac death (log-rank p=0.98) and heart failure hospitalizations (1 in pre-BAV versus 3 in no-BAV group, log-rank p=0.31). Lastly, there was no difference in the incidence of permanent pacemaker implantation between the two groups at one year (27/67 in no-BAV group versus 20/69 in pre-BAV group, log-rank p=0.24) Conclusions Direct transcatheter aortic valve implantation is non-inferior to the procedure with pre-dilatation in self-expanding valve. Despite the overall low rate of events, direct procedure has no impact on clinical outcomes at one year. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

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