Analysis of tricuspid regurgitation improvement following cardiac resynchronization therapy

This Letter to the Editor refers to article ‘Tricuspid regurgitation after cardiac resynchronization therapy: evolution and prognostic significance’ by Stassen et al. https://doi.org/10.1093/europace/euac034. We congratulate Stassen et al. for their analysis on tricuspid regurgitation (TR) improvement following cardiac resynchronization therapy (CRT) and associated findings of improved functional outcomes in this cohort.1 We believe these findings to be pertinent as a 2022 study by Livesay et al. found concurrent results in COPD patients, where a single centre analysis of 154 COPD patients found that those who had a CRT device fitted had a significantly lower incidence of TR (16%) when compared with single—(37%) (P = 0.001) and dual-chamber devices—(30%) (P = 0.02), respectively.2 Whilst both Stassen and Livesay et al. provide strong evidence for the implantation of CRT devices in those at high risk of TR to improve functional outcomes, it should be noted that His bundle pacing is providing a new avenue for this cohort of patients as well. A 2022 systematic review by Zaidi et al.3 found results that were comparable with those of Stassen et al. for the use of His bundle pacing. Of the 10 studies considered in the review four studies showed an improvement in TR grade following HBP at 12–17 month follow-up.3 Wu et al. conducted a study comparing His bundle pacing in candidates for CRT and concurred with the results of Zaidi et al., as they found baseline TR had reduced at 12 month follow-up.4 Whilst Stassen et al. provide strong evidence for the use of CRT as a viable option to stop the progression of TR, cardiac implantable electronic device (CIED) induced TR still remains a concern. Studies have shown that the incidence of TR is high in patients with CIED and is associated with an increased incidence of right ventricular dysfunction, hospitalization due to heart failure, and mortality.5,6 A 2022 meta-analysis including 8144 patients by Zhang et al. showed the pooled incidence of TR deterioration of at least two grades was 9.4% (P < 0.01) after implementation of CIED.7 Further work needs to be done differentiate the difference in TR deterioration between CRT, implantable cardioverter defibrillator, and permanent pacemaker. None declared.