Key result
New-onset severe TR develops in ~11% of pacemaker patients, predicted by age, AF, and IHD.
Why the study?
Pacemaker-induced tricuspid regurgitation impacts morbidity and mortality, but the true incidence of new-onset severe tricuspid regurgitation remains unknown.
What is the incidence and what are the predictors of new-onset severe tricuspid regurgitation in patients receiving a pacemaker?
Cohort (n=223)
What is the incidence and what are the predictors of new-onset severe tricuspid regurgitation in patients receiving a pacemaker?
New-onset severe tricuspid regurgitation occurs in approximately 1 in 10 patients following pacemaker implantation, driven independently by age, atrial fibrillation, and ischemic heart disease.
May warrant closer TR surveillance in high-risk pacemaker recipients; leaves open whether device modifications reduce incidence.
Abstract Pacemaker-induced tricuspid regurgitation has been established as an entity that can impact on the morbidity and mortality of patients receiving a pacemaker. However, a pacemaker is life-saving therapy, and the true incidence of new-onset severe tricuspid regurgitation remains unknown. Purpose To evaluate the incidence of new-onset severe tricuspid regurgitation in patients receiving a pacemaker and the factors associated with the development of severe tricuspid regurgitation. Methods Consecutive patients who received a pacemaker and had at least one echocardiogram within the year preceding the implantation and another one after implantation were included. The primary outcome was new-onset severe tricuspid regurgitation. Baseline clinical and echocardiographic characteristics were analysed to identify potential risk factors for TR worsening. Cox regression model was performed to identify independent predictors of severe TR. Results Of 223 patients (72.9 ± 12.4 years, 61.9% male), 24 patients (10.8%) presented with new severe TR. The mean time to development of severe TR was 34.5±22.3months. Compared with those without severe TR, patients with severe TR were older (78.5 ± 9.1 vs. 72.2 ± 12.5 years, p=0.006), had a higher prevalence of atrial fibrillation (70.8% vs. 39.7%, p=0.004), had higher prevalence of significant mitral regurgitation (33.3% vs. 15.1%, p=0.04) and significant mitral valve stenosis (20.8% vs. 1.0% p<0.001). Patients with mild baseline TR showed the highest incidence of significant TR progression (17.8%) (Figure 1.). Cox regression analysis was performed. Age (HR = 1.110, 95% CI: 1.043–1.181, p = 0.001), atrial fibrillation (HR = 3.488, 95% CI: 1.388–8.765, p = 0.008) and ischaemic heart disease (HR = 2.908, 95% CI: 1.229–6.883, p = 0.015) emerged as independent predictors of new-onset severe TR. Conclusion In patients with pacemaker, the development of severe TR over time occurred in 1 of 10 patients and age, atrial fibrillation, and ischaemic heart disease were independently associated with severe TR.TR worsening according to baseline TR
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Riera et al. (2026) conducted a cohort in Pacemaker-induced tricuspid regurgitation (n=223). Pacemaker implantation was evaluated on new-onset severe tricuspid regurgitation. In patients receiving a pacemaker, new-onset severe tricuspid regurgitation occurred in 10.8%, with atrial fibrillation (HR 3.488) and ischemic heart disease (HR 2.908) as independent predictors.
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