Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation

Background: Tricuspid regurgitation (TR) is a valvular heart disorder characterized by the backward flow of blood from the right ventricle into the right atrium during systole, due to incomplete closure of the tricuspid valve. While traditionally considered a benign condition, recent studies have highlighted its association with increased morbidity and mortality, particularly in moderate to severe cases. The treatment of bradyarrhythmias and heart failure has been greatly enhanced by Pacemakers, implanted cardioverter-defibrillators (ICDs), and cardiac resynchronization treatment (CRT) systems are examples of cardiac implantable electronic devices (CIEDs). However, the tricuspid valve (TV) is traversed by the transvenous leads needed for these devices, which may impair valve function. An increasingly common side effect is Lead-induced tricuspid regurgitation (LITR) is characterized by mechanical interference of the lead with chordal structures, subvalvular apparatus, or tricuspid leaflet coaptation. Tricuspid regurgitation may develop as a result, leading to right-sided heart failure, elevated morbidity, and decreased survival. LITR has a complex pathophysiology that includes fibrosis, entrapment, and lead impingement. LITR is still underdiagnosed and frequently undertreated, despite its clinical importance. Conclusion: CIED lead-induced tricuspid regurgitation is a clinically significant yet often overlooked complication. Early recognition through echocardiography, particularly with 3D imaging, is crucial for accurate diagnosis. Management strategies depend on the severity of regurgitation and patient symptoms, ranging from conservative monitoring to lead revision or surgical intervention. As the use of CIEDs continues to rise, a multidisciplinary approach to prevent, detect, and treat LITR is essential to improving patient outcomes and quality of life.