Worsening tricuspid regurgitation occurred in 35% of patients post-Micra leadless pacemaker implantation, significantly associated with procedure time exceeding 18 minutes (p < 0.001).
Does procedure time, ventricular pacing burden, ejection fraction, or number of recaptures predict worsening tricuspid regurgitation in patients undergoing leadless pacemaker implantation?
Longer procedure times (>18 minutes) during leadless pacemaker implantation are significantly associated with worsening tricuspid regurgitation.
Absolute Event Rate: 0% vs 0%
Abstract Background The relationship between tricuspid regurgitation (TR) and conventional pacemaker (PM) leads has been well documented. However, data regarding the association between TR and leadless pacemakers (LP) remain limited and inconsistent. Furthermore, the underlaying mechanisms of this association are not completely understood. Potential predictors of this complication include ventricular pacing (VP) burden, worsening ejection fraction (EF), frequency of recaptures, and procedure times. Purpose To investigate the possible predictors of tricuspid regurgitation in leadless pacemaker implantation. Methods We conducted a retrospective analysis of adult patients who underwent Micra LP implantation at our Institution from 2016 to 2022. Only those patients with an echocardiogram prior to the procedure and at follow-up were included. Data regarding change in presence or in severity of TR before and after the procedure was obtained. Additionally, EF before and after implantation, VP burden at follow-up device interrogation, frequency of recaptures, and procedure times were collected to identify potential predictors of TR. We used ordinal logistic regression to assess this association. Results Between 2016 and 2022, a total of 310 patients underwent Micra LP implantation at our Institution. Of these, 113 met inclusion criteria. The mean age was 76 years and 47.8% were female. 102 patients had some grade of TR before the implantation: Trace 42%, Trace-Mild 5%, Mild 32%, Mild-Moderate 6%, Moderate 11%, Moderate-Severe 2%, and Severe 2%. After implantation, TR worsened in 40 patients (35%), improved in 21 (19%), and remained unchanged in 52 (46%). Among those with worsening TR, 58% had a VP burden 40% and 45% had a worsening EF. Only 10% of the patients with worsening TR had 4 recaptures. This associations were not statistically significant. The mean procedure time was 18 ± 9.6 minutes. Remarkably, 80% of the patients with worsening TR had a procedure time 18 minutes (p 0.001). Conclusion There was a clinically and statistically significant association between worsening TR and procedure time during Micra leadless pacemaker implantation. On the other hand, there was a weak association between worsening TR and high VP burden, worsening EF, and number of recaptures. More studies are needed to further assess this association.
Rodríguez et al. (Sat,) reported a other. Worsening tricuspid regurgitation occurred in 35% of patients post-Micra leadless pacemaker implantation, significantly associated with procedure time exceeding 18 minutes (p < 0.001).