Effect of pacing/sensing lead addition vs. add-on ICD lead implantation for lead failure on the tricuspid valve function

Objectives The development or progression of tricuspid regurgitation (TR) following the implantation of cardiovascular implantable electronic devices (CIED) represents a significant concern. Although the link between transvalvular lead placement and TR is well established, the patient-related and lead-related factors that predispose patients to develop TR remain unclear. This study aimed to evaluate the effect of additional pacing/sensing leads (PSL) or ICD leads on tricuspid valve function in patients with lead failure. Methods In this retrospective, single-center, case-control study, all ICD implantation patients, in cases performed by one of these authors, presenting with lead failure were screened. We compared the degree of tricuspid regurgitation on pre- and postprocedural echocardiograms of patients who underwent additional PSL or ICD lead implantation. Results A total of 52 patients were included, with 28 receiving a PSL and 24 an ICD lead. The mean echocardiographic follow-up was similar between groups (19.7 ± 17.7 vs. 18.2 ± 16.5 months, p = 0.94). Neither PSL (p = 0.180) nor ICD lead addition (p = 0.089) resulted in a significant increase in TR severity. The change in TR grade was comparable between groups (p = 0.250). Conclusion This study provides the first comparative analysis of PSL versus ICD lead addition in patients with lead failure. The findings suggest that additional leads, whether PSL or ICD, do not significantly worsen tricuspid valve function.