A meta‐analysis of the distance between lead‐implanted site and tricuspid valve annulus with postoperative tricuspid regurgitation deterioration in patients with left bundle branch area pacing

Tricuspid regurgitation (TR) is a known complication of cardiac implantable electrical devices (CIEDs), with prevalences ranging from 10% to as high as 30%. Despite left bundle branch area pacing (LBBAP) has emerged as an alternative to the limits of His‐bundle pacing (HBP), the long‐term safety of this procedure, notably the worsening of TR after implantation, has yet to be thoroughly investigated. This meta‐analysis sought to determine the frequency of post‐LBBAP TR deterioration and identify the predictors, particularly the distance between lead‐implanted site and the tricuspid valve annulus (lead‐TA‐distance). A systematic literature search was conducted using PubMed, Europe PMC, and ScienceDirect for studies that reported the incidence of deterioration and measurement of TR grade at baseline and follow‐up following LBBAP, in addition to the differences in exposure between short and long lead‐TA‐distances. A total of three studies involving 480 participants were included in this meta‐analysis. The incidence of TR deterioration was 22%. Patients with TR deterioration also demonstrated a significantly shorter lead‐TA‐distance in comparison to the opposing group (MD: −5.74 mm (−0.70, −10.78); p < .001; I 2 = 92.6%). The pooled results of three comparative studies suggest that participants in the longer lead‐TA‐distance group had a significant decrement in the likelihood of TR worsening (adjusted OR = 0.59 (0.36–0.96); p = .034; I 2 = 79%). Multivariate analysis conducted in each of the included investigations supported the independence of the connection between lead‐TA‐distance and TR deterioration. A shorter lead‐TA‐distance was an independent risk factor for TR deterioration in individuals with post‐LBBAP implantation.