Cardiac Implantable Electronic Device Induced Tricuspid Regurgitation: A Mini Review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cardiac implantable electronic device (CIED)-induced tricuspid regurgitation. Intervention: Cardiac implantable electronic device (CIED) implantation. Primary outcome: CIED-associated tricuspid regurgitation.

Rana Zhafira Amanda; Sidhi Laksono Purwowiyoto

doi:10.17816/cardar626186

December 8, 2023Cardiac ArrhythmiasOpen Access

Cardiac Implantable Electronic Device Induced Tricuspid Regurgitation: A Mini Review

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Key result

CIED implantation is linked to tricuspid regurgitation in up to ~45% of patients, worsening clinical outcomes.

Why the study?

Cardiac implantable electronic device-induced tricuspid regurgitation is linked to worsening heart failure and increased mortality, necessitating better knowledge of its mechanical issues.

Key Points

Examine the pathomechanisms, diagnostic techniques, and clinical implications of tricuspid regurgitation induced by cardiac implantable electronic devices.
Synthesized published data addressing mechanical, pacing-induced, and device-related causes of tricuspid valve dysfunction after transvenous lead or leadless pacemaker placement.
Assessed diagnostic workflows, comparing two-dimensional and three-dimensional transthoracic and transesophageal echocardiography for detecting lead-leaflet interactions.
Device-associated tricuspid regurgitation prevalence ranged from 7% to 45%, with post-implantation regurgitation severity increasing by one or two grades across pacemakers and implantable cardioverter-defibrillators.
Mechanisms included lead impingement, leaflet perforation, and pacing-induced dyssynchrony, while septal insertion of leadless pacemakers demonstrated a fivefold increased risk of worsening regurgitation compared with apical placement.
Post-implantation moderate or severe tricuspid regurgitation was associated with heart failure hospitalizations beyond one year after placement and reduced long-term (>10 years) survival.

Structured PICO

P

Population

Patients with cardiac implantable electronic devices (permanent pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy, or leadless pacemakers) evaluated across 14 reviewed articles.

E

Exposure

Cardiac implantable electronic device (CIED) implantation (prolapsing, direct crossing, or dropping down techniques; apical vs. nonapical/septal pacing) and subsequent management of CIED-induced tricuspid regurgitation (medical therapy with loop diuretics and aldosterone antagonists, transvenous lead extraction [TLE], surgical valve repair or replacement, transcatheter tricuspid valve replacement [TTVR], or percutaneous transcatheter edge-to-edge tricuspid valve repair [T-TEER]).

O

Outcome

Development, severity, pathomechanisms, diagnosis, and management outcomes of CIED-induced tricuspid regurgitation (TR).

This mini-review synthesizes the mechanisms, diagnostic strategies (highlighting 3D echocardiography), and management options (medical, transvenous lead extraction, surgical, and transcatheter interventions) for CIED-induced tricuspid regurgitation, a condition linked to worsening heart failure and increased mortality.

Limitations

Heterogeneity of methodologies and populations observed in the included studies
Wide variation in study design, evaluation period, imaging technique, and availability of baseline echocardiography
Divergent interpretations of significant postprocedural tricuspid regurgitation across studies
Variation in populations observed in the included studies
Lack of restriction on the standards used in each investigation, including study design, evaluation period, imaging technique, and availability of baseline echocardiography

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Implication

Supports monitoring for tricuspid regurgitation after CIED implantation; leaves open optimal prevention and management strategies.

Abstract

The continuing application of cardiac implantable electronic devices (CIED) has led to an increasing concern regarding disturbances in the tricuspid valve (TV). The most prevalent TV issue related to lead implantation is tricuspid regurgitation. CIED-induced tricuspid regurgitation is associated with emerging or worsening preexisting heart failure and increased mortality rate. Because discontinuing the implantation of these instruments is not feasible, further knowledge of their mechanical problems may lead to advancements. This review addresses the available data regarding CIED-induced tricuspid regurgitation, elucidating its plausible pathomechanisms, diagnostic methods, and prospective treatments.

Discussion

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Cite This Study

Amanda et al. (2023) conducted a review in Cardiac implantable electronic device (CIED)-induced tricuspid regurgitation. Cardiac implantable electronic device (CIED) implantation was evaluated on CIED-associated tricuspid regurgitation. Cardiac implantable electronic device implantation is associated with a 7% to 45% prevalence of tricuspid regurgitation and increased risks of heart failure and mortality.

synapsesocial.com/papers/6a731bd9a3cf5acb16a0b919 https://doi.org/10.17816/cardar626186

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Cardiac Implantable Electronic Device Induced Tricuspid Regurgitation: A Mini Review

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiac Implantable Electronic Device Induced Tricuspid Regurgitation: A Mini Review

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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