Progression of tricuspid regurgitation in patients with right ventricular pacing.

OBJECTIVE

To compare the prevalence and progression of tricuspid regurgitation (TR) after the implantation of right-ventricular pacing cardiac implantable electronic devices (CIEDs) versus biventricular pacing devices.

BACKGROUND

TR in patients with CIEDs is often linked to mechanical interference from leads, but studies show TR can also progress with leadless pacemakers, suggesting a direct effect of pacing.

METHODS

We conducted a retrospective analysis of 549 patients who received a pacemaker (PM), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy (CRT) device. Follow-ups were conducted after one year and at least three years with aggregate interrogation and transthoracic echocardiography performed. Patients were categorized into two groups: right-ventricular (RVall) pacing and biventricular (BiV) pacing.

RESULTS

Median age was 68 [57-76] years, with 419 (76.3%) being male. Of these patients, 21.5% received an ICD, 30.4% a PM, and 48.1% a CRT device (RVall: n = 285; BiV: n = 264). BiV patients had worse left ventricular (LV) function and more pronounced evidence of RV dilatation at baseline. After three years, a relevant TR was more prevalent in the RV paced patients (RVall: 17.4%; BiV: 9.8%). Also, an increase in TR grade of ≥I° and ≥II° was more frequent in the RVall group. While tricuspid annular systolic excursion (TAPSE) deteriorated in the RVall group, it was preserved in the BiV group.

CONCLUSIONS

RV pacing was associated with a higher prevalence and severity of TR after CIED implantation compared to BiV pacing, but this effect might also be explained by significant differences in the group's clinical characteristics.