Tricuspid Valve Function After Add-On Pacing/Sensing Lead vs ICD Lead Implantation for Failed IS-1/DF-1 ICD Leads: A Single-Center Experience.

BACKGROUND: The development or progression of tricuspid regurgitation (TR) following the implantation of cardiac 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 implantable cardioverter defibrillator (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. The degree of TR on pre- and post-procedural echocardiograms of patients who underwent additional PSL or ICD lead implantation is compared. RESULTS: The study comprised a total of 52 patients; 28 patients received PSL, and 24 patients received ICD electrodes. A non-significant increase in the degree of TR was observed in patients who underwent new ICD lead implantation (P = .059). The degree of TR observed in patients who underwent new PSL implantation was found to be comparable to the pre-procedure levels (P = .180). However, no statistically significant differences were observed between the 2 groups with respect to change in TR degree (P = .123). CONCLUSION: This study is the first analysis comparing the effect of ICD electrode addition with PSL addition without lead extraction on right ventricular and tricuspid valve function in patients with lead failure. 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. The addition of PSL to the IS-1/DF-1 ICD lead with standard high-voltage leads may be a viable treatment option, as it yields similar results to a new ICD lead implantation in terms of right heart function.