Abstract 4368541: Three-Dimensional Echocardiographic Evaluation of Tricuspid Regurgitation Associated with Cardiovascular Implantable Electronic Devices

Background: Cardiovascular implantable electronic devices (CIEDs) are increasingly utilized to manage cardiac rhythm disorders and improve patient outcomes. However, their placement may interfere with tricuspid valve function, potentially leading to tricuspid regurgitation (TR), which is associated with adverse cardiac events. Objectives: To evaluate the association between CIEDs and TR, and to investigate the role of lead position and device type using three-dimensional (3D) echocardiography. Methods: This retrospective case-control study included patients who developed moderate or severe TR after CIED implantation at a tertiary hospital. Controls with mild TR post-CIED were matched by age, sex, and index year. Patient and device data were collected, and TR severity was assessed using 2D and 3D echocardiography. Lead location, leaflet interference, and device type were analysed as potential predictors of TR using logistic regression. Results: A total of 35 patients with moderate/severe TR and 105 matched controls were included. Compared to the mild TR group, the moderate/severe TR group had significantly larger atrial and ventricular dimensions and more frequent leaflet interference. Posterior and septal leaflets were most commonly affected. Interfering leads were present in 65.7% of the moderate/severe TR group versus 10.5% of controls. Single-chamber pacing and implantable cardioverter-defibrillator (ICD) placement were independently associated with increased TR risk, while dual-chamber pacing showed a protective effect. Atrial fibrillation and lead interference significantly increased the odds of developing significant TR. Conclusions: Preimplantation atrial fibrillation, device type (particularly single-chamber pacing and ICDs), and interfering lead positions are associated with post-implantation TR. 3D echocardiography is a valuable tool for assessing lead-related TR and should be considered in the evaluation of patients with CIEDs.