Insights of tricuspid regurgitation mechanisms in patients with right
ventricular apical pacing by three-dimensional echocardiography.
Abstract
Objective: Device lead-induced tricuspid regurgitation (LITR)
mechanisms are well-defined by 3D transthoracic echocardiography
(3D-TTE). There is a lack of data on the Latin-American population. The
objective of this study was to describe the prevalence of several
mechanisms and insights in patients with permanent right ventricular
(RV) implanted devices by 3D-TTE examination. Methods: We
performed a cross-sectional analysis of 101 patients with permanent
cardiac devices such as pacemakers or defibrillators. 3D-TTE was
obtained on all patients in RV-focused apical views to perform a
complete tricuspid valve (TV) evaluation: leaflets, subvalvular
apparatus, precise lead location, and functional assessment to evaluate
possible mechanisms of tricuspid regurgitation (TR). Results:
In a total of 101 patients, the leads did not interfere with TV function
in 53 p. (59%), while LITR was observed in 38 (41%) patients.
Adherent, impinging, entangled, and mixed lead-induced mechanisms were
observed. Time in years since device implantation was significantly
higher in patients with LITR. Conclusions: LITR was present in
a high proportion of our population. LITR is the result of damage to the
TV as well as its subvalvular apparatus due to the fibrotic and
inflammatory response over time when leads are situated in unfavorable
locations.