Percutaneous lead extraction may be considered for managing endocardial lead-related tricuspid regurgitation and right ventricular dysfunction.
ELTR warrants monitoring in device patients with right heart failure; case reports extend mechanistic awareness but leave prospective validation open.
Endocardial lead–related tricuspid regurgitation (ELTR) is an increasingly recognized complication of cardiac device implantation that can result in right ventricular (RV) dysfunction and right heart failure.1 Several mechanisms of ELTR have been proposed, including lead impingement on tricuspid valve (TV) leaflets; leaflet perforation; entanglement within the valve apparatus; adherence to TV leaflets, chordae, or papillary muscles; and altered RV activation or geometry owing to RV pacing.1,2 Irrespective of the mechanism(s) involved, it has been postulated that the mechanical and hemodynamic consequences of ELTR on the TV and RV should manifest by 6 months post–device implantation, delineating the time period during which compatible signs and symptoms should most raise suspicion for this condition and suggesting that early intervention may be important.
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Ramirez et al. (2016) studied this question.
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