Effect of Right Ventricular Lead Placement on Tricuspid Valve: Added
Value of Post-procedural Fluoroscopy to Three Dimensional
Echocardiography in a Prospective Cohort Study
Abstract
Introduction. Use of implantable endocardial electronic devices is
widely increasing due to pro-longed life span of the community. Several
studies evaluated the effect of right ventricular (RV) leads on
tricuspid valve by three-dimensional transthoracic echocardiography
(3D-TTE); howev-er, this affect has not yet been assessed by
post-procedural fluoroscopy. Hence, the purpose of the current study was
to evaluate the effect of RV lead placement on tricuspid valve,
utilizing fluoroscopy in combination with 3D-TEE. Methods. We
prospectively enrolled 59 patients who underwent clinically indicated
pacemaker or implantable cardioverter defibrillator (ICD) implantation.
Vena contracta (VC) and tricuspid regurgitation (TR) severity were
measured using two-dimensional transthoracic echocardiography (2D-TTE)
at baseline. Follow up 3D-TTE was performed six months after device
implantation to assess TR severity and RV lead location. Results. TR VC
was increased after the lead placement, compared to the baseline study
(VC: 3.86 ± 2.32 vs 3.18 ± 2.39; p = 0.005). The mean changes in VC
levels were 1.14 ± 0.67 mm (Range: -0.4-2.5 mm) after inserting the
lead. Among all investigated parameters, VC changes were predicted based
on lead placement position only in 3D-TTE (p<0.001) while the
other var-iables including fluoroscopy parameters were not predictive.
Conclusion. The RV Lead location examined by 3D-TTE seems to be a
valuable parameter to predict the changes in the severity of the
tricuspid regurgitation. Fluoroscopy findings did not improve the
predictive performance ,at least in short term follow up.