Progression of Tricuspid Regurgitation After Cardiac Implantable Electronic Device Implantation and Its Impact on Mortality and Hospitalization: A Single‐Center Cohort Study

Introduction Tricuspid regurgitation (TR) progression is a recognized complication of cardiac implantable electronic device (CIED) implantation, yet its prognostic impact on long‐term clinical outcomes remains incompletely defined. Methods and Results In this single‐center retrospective cohort, 303 patients undergoing CIED implantation between 2005 and 2023 were followed for a median of 4.8 years. TR severity was assessed echocardiographically at baseline and 12 months. The primary endpoint was TR progression (≥ 1‐grade worsening); secondary endpoints were all‐cause mortality, cardiovascular hospitalization, their composite, and progression to severe TR, analyzed by Kaplan–Meier and Cox regression. TR progressed in 103 patients (34.0%), regressed in 33 (10.9%), and remained stable in 167 (55.1%), a net rightward shift ( p < 0.001). Progression differed by device type ( p = 0.031): among the larger subgroups, VVI‐ICD showed the greatest net progression (31.8% worsened vs. 6.9% improved; p < 0.001) and CRT‐D the highest regression (18.8%). During follow‐up, 67 patients (22.1%) died and 164 (54.1%) were hospitalized. Overall TR progression was not independently associated with mortality (HR 1.118, p = 0.693) but independently predicted cardiovascular hospitalization (HR 1.640, p = 0.003) and the composite endpoint (HR 1.480, p = 0.014). On unadjusted analysis, progression specifically to severe TR ( n = 15) was associated with increased mortality (HR 1.99, p = 0.024) and cardiovascular hospitalization (HR 2.45, p < 0.001). Conclusion TR progression occurs in approximately one‐third of CIED recipients within the first year and independently predicts cardiovascular hospitalization. Progression to severe TR identifies a higher‐risk subset, supporting routine post‐implant echocardiographic surveillance.