Do transvenous pacemaker leads increase the prevalence of moderate to severe tricuspid regurgitation?
This study aims to determine if transvenous pacemaker leads are associated with an increased prevalence of moderate to severe tricuspid regurgitation using a large echocardiography database.
Since the original description of the use of an endocardial transvenous lead for permanent cardiac pacing, 1 Furman S Schwedel J An intracardiac pacemaker for Stokes-Adams seizures. N Engl J Med. 1959; 261: 943-948 Crossref PubMed Scopus (225) Google Scholar the technology in this field has evolved rapidly. At the present time, pacing leads are highly flexible multihelical combinations of a metal alloy conductor and a pliable polyurethane or silicone insulation. However, the necessity for intracavitary right ventricular placement of endocardial leads has not changed since their early development. Anatomy mandates that endocardial ventricular leads be placed across the tricuspid valve, and this is associated with the potential risk of tricuspid valve malfunction. Some investigators have noted the appearance of a new murmur after pacemaker implantation and its disappearance after withdrawal of the lead. 2 Rubio P.A al-Bassam M.S Pacemaker lead puncture of tricuspid valve successful diagnosis and treatment. Chest. 1991; 99: 1519-1520 Crossref PubMed Scopus (32) Google Scholar , 3 Cairns B.B.K Kloster F.E Bristow J.D Lees M.H Griswold H.E Problems in the hemodynamic diagnosis of tricuspid insufficiency. Am Heart J. 1968; 75: 174-179 Abstract Full Text PDF Scopus (65) Google Scholar Others have reported severe tricuspid valve malfunction due to valvular disruption by an endocardial lead. 2 Rubio P.A al-Bassam M.S Pacemaker lead puncture of tricuspid valve successful diagnosis and treatment. Chest. 1991; 99: 1519-1520 Crossref PubMed Scopus (32) Google Scholar , 4 Gibson T.C Davidson R.C DeSilvey D.L Presumptive tricuspid valve malfunction induced by a pacemaker lead a case report and review of the literature. PACE. 1980; 3: 88-95 Crossref Scopus (47) Google Scholar , 5 Fishenfeld J Lamy Y Laceration of tricuspid valve. Chest. 1972; 61: 697-698 Crossref PubMed Scopus (25) Google Scholar , 6 Petterson S.R Singh J.B Reeves G Kocot S.L Tricuspid valve perforation by endocardial pacing electrode. Chest. 1973; 63: 125-126 Crossref PubMed Scopus (27) Google Scholar , 7 Gould L Reddy R Yacob U Teich M DeMartino A DePalma D Gomprecht R.F Perforation of the tricuspid valve by a transvenous pacemaker. JAMA. 1974; 230: 86-87 Crossref PubMed Scopus (43) Google Scholar However, because of the nature of case reports, these represent extreme cases, and the true prevalence of tricuspid regurgitation (TR) in patients with endocardial pacing leads remains unknown. The purpose of this study was to analyze a large echocardiography database to determine whether transvenous pacemaker leads are associated with an increased prevalence of moderate to severe TR.
Paniagua et al. (Sun,) studied this question.
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