Deterioration of chronic heart failure due to lead-associated tricuspid regurgitation: a review

Implantable intracardiac devices, including permanent pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapy systems, have become firmly established in clinical practice and demonstrated efficacy in improving prognosis in patients with bradyarrhythmias, high risk of sudden cardiac death, and chronic heart failure. However, with the increasing number of implantations, late complications are attracting more attention, particularly tricuspid regurgitation associated with implanted intracardiac leads. It has been shown that lead-associated tricuspid regurgitation may be linked to worsening heart failure symptoms, increased hospitalization rates, and reduced survival. Nevertheless, the pathophysiologic mechanisms of this condition, its clinical course, and diagnostic approaches remain insufficiently standardized, and current clinical guidelines lack clear management algorithms. According to published data, the prevalence of tricuspid regurgitation after lead implantation ranges from 7% to 39%, reflecting heterogeneity across reports and the absence of unified diagnostic criteria. This considerably complicates assessment of the true prevalence and clinical significance of this complication. An additional challenge is the choice of treatment strategy, especially when deciding on transvenous lead extraction or surgical correction. Thus, an individualized and multidisciplinary approach is required for each patient, and further investigations are needed to develop consistent clinical recommendations.