Long-term progression of tricuspid regurgitation after transvenous lead extraction

Background Acute tricuspid regurgitation (TR) following transvenous lead extraction (TLE) has been described. However, the long-term progression of TR is not well characterized. Objective To evaluate the prevalence of long-term TR progression after TLE and association with adverse clinical outcomes. Methods Patients who underwent TLE of at least one transvalvular lead between 2015 to 2022 with serial echocardiograms up to three years post-procedure were included. TR progression was defined as an increase in TR by at least two grades, or if TR becomes severe. Results Of 245 patients included in the study, TR progression was observed in 33 patients (13%). Predictors of TR progression include heart failure (OR 3.00, 95% CI [1.24-7.22], p=0.014) and pre-existing moderate TR (OR 8.26, 95% CI [3.42-19.92], p < 0.001). After multivariable analysis, severe TR (HR 1.83, 95% CI [1.01-3.34], p=0.048), atrial fibrillation (HR 2.11, 95% CI [1.26-3.53], p=0.004), chronic kidney disease (HR 2.08, 95% CI [1.22-3.55], p=0.007), and diabetes (HR 2.49, 95% CI [1.47-4.22], p < 0.001) were associated with composite of heart failure hospitalization, tricuspid valve intervention, and mortality. Conclusion The long-term prevalence of TR progression after TLE was 13%, with heart failure and pre-existing moderate TR as clinical predictors. Severe TR was associated with worse outcomes. Longitudinal follow up and multidisciplinary management should be considered for patients who are referred for lead extraction.