Improvement in lead-related tricuspid regurgitation after transvenous lead extraction: A prospective multicenter study.

BACKGROUND

Cardiac implantable electronic device leads can cause or exacerbate tricuspid regurgitation (TR) through mechanical leaflet impingement and subsequent structural remodeling. The extent to which TR improves after transvenous lead extraction (TLE) remains unclear.

OBJECTIVES

This study aimed to evaluate changes in TR severity after TLE in patients with severe, lead-related TR and identify predictors of improvement.

METHODS

This prospective, multicenter registry included 25 consecutive patients with severe TR and echocardiographic evidence of cardiac implantable electronic device lead impingement who underwent TLE at 4 institutions. The primary endpoint was improvement in TR severity on follow-up echocardiography.

RESULTS

Mean age of the patients was 65 ± 19 years, and 44% were male. Pacemakers accounted for 68% of devices, with a mean lead dwell time of 5.6 ± 6.2 years. All patients had severe TR prior to extraction. Following TLE, 9 patients (36%) demonstrated improvement in TR severity. Improvement typically began within 3-4 months and progressed during the first year of follow-up. Patients with TR improvement had significantly shorter lead dwell times compared with those without improvement (2.6 ± 1.6 vs 8.2 ± 6.9 years; P = .025).

CONCLUSION

In this prospective multicenter cohort, over one-third of patients with severe, lead-related TR experienced meaningful improvement after TLE. Shorter lead dwell time was associated with a higher likelihood of recovery, suggesting that earlier intervention may increase the likelihood of reversibility when TR is caused by leaflet impingement. These findings support timely consideration of TLE in selected patients and warrant validation in larger studies.