Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
Progression of Tricuspid Regurgitation in Patients with Continuous Right Ventricular Pacing
M. Ivannikova1, A. Goncharov1, V. Sciacca2, K. Friedrichs3, T. K. Rudolph1, L. Bergau4, T. Fink5, T. Eitz6, P. Sommer2, V. Rudolph1, C. Sohns2, M. Gercek3
1Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 2Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 3Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 4Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen; 5Elektrophysiologie/ Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 6Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Background:

Lead-related tricuspid regurgitation (TR) is a known complication of pacemaker/cardiac defibrillator therapy and belongs to the primary causes of TR. The origin of TR hereby seems to be multifactorial such as the lead-diameter and the implantation position. However, little is known about the impact of continuous right ventricular pacing on the progression of TR. Thus, we aimed to analyse and compare the course of TR in patients with continuous right ventricular pacing with patients with biventricular pacing in an at least 3-years follow up.

Methods: 

We retrospectively analyzed 549 patients who underwent a permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or a system for cardiac resynchronization therapy (CRT) implantation at our center between 2006 and 2017 and had eligible 3 years follow up data. TR progression was evaluated using transthoracic echocardiography (TTE) immediately after implantation, at 1 year, and at least 3 years follow up. The median follow-up time was 54 months (IQR: 40.0-74.0).

Results: 

Median age of the patients was 68.3 years (IQR: 57.0-75.6) and 76.3% were male. PPM was implanted in 167 patients (30.4%), ICD in 118 (21.5%) and CRT in 264 (48.1%). To identify the difference in the effect of isolated right ventricular (RV) and biventricular (bivent) pacing on the severity of TR, patients were divided into 2 groups: RV-pacing (285 patients) (210 of them with >50% RV-pacing) vs bivent-pacing (264 patients). Immediately after device implantation, the rate of relevant TR (TR ≥ moderate) was comparable between groups (7.9% vs 7.2%, p=0.79). While a slight trend of TR progression was identifiable in the RV pacing group after 1 year (9.5% vs 6.1%; p=0.16), TR ≥ moderate became significantly more frequent in the RV pacing group (17.4% vs 9.8%; p=0.012) at 3 years (Figure 1). Multivariable regression analysis revealed that RV-pacing was independently associated with TR progression (OR 0.99, 95% CI: 0.98 – 0.99; p=0.031). Additionally, there was a significant worsening of the longitudinal RV-function (TAPSE) during the follow up in the RV-pacing group (20.5 ± 5.5 mm vs 18.7 ± 5.3 mm, p<0.001).

Conclusion: 

Continuous right ventricular pacing is independently associated with TR progression in patients with PPM and ICD therapy, which should be taken into consideration when selecting the pacing strategy.
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