Key result
Cardiac implantable electronic device implantation was associated with a median 15.4% incidence of tricuspid regurgitation development or progression across 78 studies.
Why the study?
Cardiac implantable electronic device-related tricuspid regurgitation is increasingly recognized as clinically relevant, yet definitions, mechanisms, and management strategies remain heterogeneous.
Systematic Review (n=54,115)
CIED-related TR is a multifactorial condition with a median incidence of 15.4%, requiring standardized definitions and mechanism-based classification to optimize management.
BACKGROUND: Cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as a clinically relevant entity, yet definitions, mechanisms, and management strategies remain heterogeneous. This scoping review aimed to systematically map existing evidence on definitions, incidence, mechanisms, predictors, clinical outcomes, and management of CIED-related TR. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, and CENTRAL without date restrictions. Studies reporting on TR in patients with pacemakers, implantable cardioverter defibrillators, or cardiac resynchronization therapy devices were included. Seventy-eight studies comprising 54,115 patients were identified and analyzed. RESULTS: Definitions and diagnostic criteria for TR varied widely across studies, and only a minority of studies systematically reported the underlying mechanism of TR. Incidence of TR development or progression after CIED implantation showed substantial variability (median 15.4 %, IQR 25.25 %), with higher rates observed in patients with pre-existing right heart disease. Mechanisms of TR were leaflet impingement or restriction, entanglement, perforation, and pacing-related right ventricular remodeling. Identified predictors of TR development or progression included pre-existing TR, right ventricular dysfunction, atrial fibrillation, and obesity. Management strategies comprised conservative therapy, transvenous lead extraction, surgical repair, and increasingly, transcatheter tricuspid valve interventions for severe TR. CONCLUSIONS: CIED-related TR represents a multifactorial condition with heterogeneous definitions and management strategies. Mechanism-based classification, standardized imaging approaches, and prospective studies are needed to better characterize TR entities, compare studies' outcomes, and investigate optimal management strategies in this growing patient population.
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Bannehr et al. (2026) conducted a systematic review in Cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) (n=54,115). Cardiac implantable electronic devices was evaluated on Incidence of TR development or progression after CIED implantation. Cardiac implantable electronic device implantation was associated with a median 15.4% incidence of tricuspid regurgitation development or progression across 78 studies.
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