Impact of implantable transvenous device lead location on severity of tricuspid regurgitation

Karima Addetia, Francesco Maffessanti, Anuj Mediratta, Megan Yamat, Lynn Weinert, Joshua D. Moss, Hemal M. Nayak, Martin C. Burke, Amit R. Patel, Eric Kruse, Valluvan Jeevanandam, Victor Mor-Avi, Roberto M. Lang

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR.

Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis.

Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively.

Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.

Original languageEnglish (US)
Pages (from-to)1164-1175
Number of pages12
JournalJournal of the American Society of Echocardiography
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Keywords

  • Intracardiac defibrillator
  • Pacemaker
  • Three-dimensional echocardiography
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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