Long-term evaluation of factors potentially affecting tricuspid valve and right heart chamber function in patients with two endocardial right ventricular pacing leads

Aim . To assess factors influencing the degree of tricuspid regurgitation (TR) and the function of the right heart chambers in patients with two endocardial right ventricular leads of a permanent pacemaker. Methods . A retrospective analysis of 5807 electronic medical records of patients who underwent primary implantation or planned replacement of a permanent pacemaker was performed. In 119 cases, a new right ventricular lead was additionally implanted, of which a group of 27 patients was selected according to the selection criteria. A control group of 129 patients was formed. Pseudo-randomization was performed, 27 comparable pairs were formed. To determine the predictors of TR progression, the logistic regression method for a multivariate model was used. Results . In the late postoperative period, echocardiographic indices of both groups were virtually identical and were within the age norms. In the control group, minor TR was detected in 62.9% (n=17) of patients, moderate indices were diagnosed in 29.7% (n=8) of cases, and no TR was detected in 7,4% (n=2), respectively. In the observation group, minor TR was diagnosed in 74,1% of cases (n=20), moderate indices of insufficiency were diagnosed in 18.5% (n=5), severe TR was recorded in 3,7% (n=1) of patients, and TR was not detected in the same number of patients. Multivariate logistic regression identified the only independent predictor of TR progression in the postoperative period - the presence of non-paroxysmal atrial fibrillation (AF), which increases the probability of progression of the degree of tricuspid valve insufficiency in the remote observation period by 3/8 times. The relationship between the fact of the presence of two electrodes in the right ventricular cavity and the increase in the degree of tricuspid valve insufficiency was not determined. Conclusion . In patients with two right ventricular leads, TR and right heart function don’t change significantly in the long-term observation period. The leading factor influencing TR progression is the history of non-paroxysmal AF.