Cardiac Pacemaker and the Effect on Hemodynamics of the Tricuspid Valve

Placement of ICDs, permanent pacemakers and biventricular devices is performed under fluoroscopic guidance. Implantable device leads can cause Tricuspid Regurgitation (TR) when they interfere with leaflet motion. In our clinical experience, we had two cases where patients with endocardial right ventricle leads developed severe TR. One patient was treated by having his leads repositioned and the other required surgery. This study analyzed the grade of tricuspid regurgitation before and after implantation of lead pacmencker in Right Ventrecle. Aim: Evaluation of tricuspid regurgitation after right ventricular permanent lead implantation to check if echocardiographic guidance is needed for adequate lead positioning. Methods: 76 patients had trans-thoracic Doppler echocardiographic studies before and after implantation of permanent right ventricular leads. Results: Before Right Ventricular (RV) lead implantation, 96% of patients had Tricuspid Regurgitation (TR). Patients were stratified by grade of regurgitation. 57 patients were grade 1 (75%), 12 (16%) were grade 2 and 4 were grade 3 or 4 (5%). After RV lead implantation, 44 patients with grade 1 TR remained with the same degree (77%) while in 2 (3.5%) TR progressed to grade 2 and in the remainder the TR disappeared. Most of the patients with grade 2 TR before RV lead implantation (75%) remained in grade 2 while 25% the grade decreased to grade 1. In all the patients with grade 3 and 4 TR pre-implantation, the severity of TR decreased by one grade. In 56 patients with non-CRT device implantations, 39 (70%) had grade 1 TR before procedure. After implantation, 28 (72%) of them did not change grade and 11 (28%) progressed to grade 2. Regarding grade 2 TR before implantation in 8 patients (14%) – the TR grade decreased in 3 (37.5%) and did not change in the others. In 3 (5.4%) patients with grade 3 and 4 TR before the procedure, the TR decreased after procedure. Conclusion: Implantation of permanent RV leads did not worsen TR grade.