Severe Tricuspid Regurgitation in a Patient With a Cardiac Implantable Electronic Device

Figures

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  Figure 1. ECGs and Chest X-Rays in Relation With the CIED Implant (A) Electrocardiogram at presentation showing high-degree atrioventricular block. (B) Chest radiograph showing right ventricular lead position. (C) Electrocardiogram showing atrioventricular asynchronous ventricular pacing. (D) Chest radiograph showing right atrial and coronary sinus leads.

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  Figure 2. Color Doppler Echocardiography Showing the TR in Relation With the CIED Implant and TLE Color Doppler echocardiography of the tricuspid valve showing different grades of tricuspid regurgitation in relation with the presence of the permanent pacemaker (PPM) (A and B) and after transvenous lead extraction (TLE) (C).

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  Figure 3. Management of CIED-Associated TR aSuspicion of cardiac implantable electronic device (CIED)-induced tricuspid regurgitation (TR) also includes a potential “superimposed/mixed CIED-TR component.” bTwo-dimensional (2D) echocardiography can provide clues of primary (eg, TR jet hugging the lead, leaflet malcoaptation/malalignment, lead adherence to the subvalvular structures with a uniform movement, extreme lead displacement against the septum) or secondary CIED-induced TR (eg, new left ventricular/right ventricular [LV/RV] dysfunction/dysfunction with interventricular dyssynchrony). cSubstantial RV pacing (RVP) of ≥20% to 40% may induce cardiomyopathy in a subset of patients. dChronically indwelling leads inducing TR may lead to a “common final pathway” that may obscure the original TR mechanism. CRT = cardiac resynchronization therapy; pHTN = pulmonary hypertension; TEER = transcatheter edge-to-edge repair; TLE = transvenous lead extraction; TTVR = transcatheter tricuspid valve replacement; TV = tricuspid valve.