Key result
Transvenous ICDs were significantly associated with greater tricuspid regurgitation severity compared to subcutaneous ICDs (adjusted OR 9.90, p=0.002).
Why the study?
It was unclear whether post-ICD worsening tricuspid regurgitation is primarily lead-related, driven by right ventricular pacing, or reflects natural progression in a high-risk population.
Does transvenous ICD implantation compared to subcutaneous ICD implantation increase the severity of tricuspid regurgitation?
Cohort (n=118)
Does transvenous ICD implantation compared to subcutaneous ICD implantation increase the severity of tricuspid regurgitation?
Answers are grounded in this paper and cite their sources.
Transvenous ICDs are associated with significantly greater worsening of tricuspid regurgitation compared to subcutaneous ICDs, suggesting the mechanism is primarily lead-related rather than natural disease progression.
BACKGROUND: Transvenous implantable cardioverter-defibrillators (TV-ICDs) are associated with greater tricuspid regurgitation (TR) severity, which leads to increased mortality. The pathophysiology is assumed to be lead-related, hence, treatment includes lead extraction. However, TR may also naturally occur in the high-risk ICD population, or may be caused by right ventricular pacing. We sought to evaluate the effect of ICD type (with or without lead) and pacing percentage on post-implantation TR severity. METHODS: In this retrospective cohort study, consecutive patients were included with a primary S-ICD or TV-ICD implantation between 2009 and 2019 and echocardiography studies ≤3 months before and ≤ 3 years post-implantation. The effect of ICD type on TR severity at follow-up was estimated adjusting for ventricular pacing percentage and potential confounders. The effect of ventricular pacing percentage on TR severity at follow-up was adjusted for potential confounders. RESULTS: 118 patients were included (mean age 52 ± 21): 31 (26%) with an S-ICD and 87 (74%) with a TV-ICD. Median 20 months post-implantation, worsening TR was found in 11/31 (34%) S-ICD patients and 45/87 (52%) TV-ICD patients (p = 0.15). Adjusted for age, atrial fibrillation, baseline TR and mitral regurgitation, ventricular pacing percentage, ICD dwelling time, BMI, hypertension and left ventricular ejection fraction, TV-ICDs were significantly associated with greater TR severity (OR 9.90, p = 0.002). Ventricular pacing percentage was very low, and not significantly associated with greater TR severity (OR 0.95, p = 0.066). CONCLUSIONS: Our results suggest that greater TR severity in ICD patients is mainly caused by the transvenous lead, rather than natural progression in the ICD population.
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Breeman et al. (2023) conducted a cohort in ICD implantation (n=118). Transvenous implantable cardioverter-defibrillators (TV-ICD) vs. Subcutaneous implantable cardioverter-defibrillators (S-ICD) was evaluated on Worsening tricuspid regurgitation severity (OR 9.90, p=0.002). Transvenous ICDs were significantly associated with greater tricuspid regurgitation severity compared to subcutaneous ICDs (adjusted OR 9.90, p=0.002).
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