Deterioration of Chronic Heart Failure Due to Lead-Associated Tricuspid Regurgitation

Implantable intracardiac devices, including permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy systems, have become an integral part of clinical practice and have demonstrated their effectiveness in improving prognosis in patients with bradyarrhythmias, high risk of sudden cardiac death, and chronic heart failure (CHF). However, with the growing number of device implantations, increasing attention is being paid to long-term complications, particularly tricuspid regurgitation (TR) associated with intracardiac leads. It has been shown that lead-associated TR may be linked to worsening of heart failure symptoms, increased frequency of hospitalizations, and reduced survival. Nevertheless, the pathophysiological mechanisms of this condition, its clinical course, and diagnostic approaches remain insufficiently standardized. Furthermore, current clinical guidelines lack clear algorithms for the management of such cases. According to the literature, the reported prevalence of TR following lead implantation ranges from 7% to 39%, reflecting the heterogeneity of studies and the absence of unified diagnostic criteria. This significantly complicates the assessment of the true prevalence and clinical relevance of this complication. Additional challenges arise in selecting an appropriate treatment strategy, particularly regarding the decision for transvenous lead extraction or surgical correction. Therefore, an individualized and multidisciplinary approach is required for each patient, as well as further research aimed at developing consistent clinical guidelines.