Cardiac implantable electronic device implantation was associated with a 65% higher adjusted risk of incident tricuspid regurgitation and a 3-fold increased risk of tricuspid intervention.
Cohort (n=16,889,936)
Yes
Does cardiac implantable electronic device (CIED) implantation increase the risk of developing clinically relevant tricuspid regurgitation and requiring tricuspid intervention in the general adult population?
CIED implantation is independently associated with an increased risk of developing clinically relevant tricuspid regurgitation and requiring subsequent tricuspid valve intervention, though the risk magnitude is smaller than other cardiovascular comorbidities.
Effect estimate: HR 1.65
BACKGROUND: Cardiac implantable electronic devices (CIED) with right ventricular leads may mechanically restrict the tricuspid valve leaflets, leading to clinically relevant tricuspid regurgitation (TR). OBJECTIVE: This study aimed to examine the impact of CIED implantation on the development of new clinically relevant TR and tricuspid interventions in all Californians seeking inpatient or procedural care. METHODS: Using California's Department of Health Care Access and Information databases, a longitudinal Cox proportional-hazards analysis of adults who received care in an emergency department, hospital, or outpatient surgery facility from 1 October 2015 to 31 December 2020 was performed. Patients with rheumatic or congenital heart disease, endocarditis, and carcinoid were excluded. Outcomes were (1) the development of TR and (2) tricuspid intervention. RESULTS: Of 16,889,936 patients contributing 54,650,137 person-years, there were 10,757 instances of TR over a median follow-up period of 3.55 years. In the unadjusted analyses, CIED implantation was associated with a 17-fold higher risk of incident TR. After adjusting for demographics and medical comorbidities, patients with a CIED exhibited a 65% higher risk of TR. Heart failure, pulmonary hypertension, hypertension, and atrial fibrillation each exhibited larger magnitudes of risk for TR than having a CIED. In the same population, 72 tricuspid valve interventions were identified. After multivariable adjustment, CIED implantation was associated with a 3-fold increased risk of tricuspid intervention. CONCLUSION: Patients with a CIED experienced a higher risk of TR and tricuspid interventions, although the magnitude of the hazard was smaller than other cardiovascular risk factors.
Bowman et al. (Thu,) conducted a cohort in Tricuspid regurgitation (n=16,889,936). Cardiac implantable electronic devices (CIED) vs. No CIED was evaluated on Development of tricuspid regurgitation and tricuspid intervention (HR 1.65). Cardiac implantable electronic device implantation was associated with a 65% higher adjusted risk of incident tricuspid regurgitation and a 3-fold increased risk of tricuspid intervention.