Lead-related tricuspid regurgitation and ventricle dysfunction: Current management and future perspectives

The implantation of cardiac implantable electronic devices (CIEDs) may result in or worsen previously existing tricuspid regurgitation (TR). The prevelence of lead-related tricuspid regurgitation (LRTR) in patients with CIEDs is between 7.2% and 44.7% when the degree of worsening TR is not reported, or from 9.8% and 38% when it is diagnosed as worsening of TR severity by at least 2 grades after a CIED has been implanted. It has been suggested that a CIED lead positioned over or pinning a leaflet may be the main cause of TR in this patient population. The septal and posterior leaflets of the tricuspid valve have been reported to be the most affected by CIED leads. Severe LRTR is related to the development of heart failure (HF) or worsening of previously existing dysfunction; it is also associated with elevated mortality. However, there are no definitive predictors of LRTR development or standardized methods of treatment. Some studies have suggested that imaging guided lead placement can reduce the occurrence of LRTR. This review summarizes current knowledge concerning the development, evaluation, consequences, and management of LRTR.

Automated summary

The implantation of cardiac implantable electronic devices (CIEDs) may lead to or worsen tricuspid regurgitation (TR). The prevalence of lead-related tricuspid regurgitation (LRTR) in patients with CIEDs ranges from 7.2% to 44.7% when the worsening degree of TR is not reported, or from 9.8% to 38% when it is diagnosed as worsening of TR severity by at least 2 grades after a CIED has been implanted. It has been suggested that the positioning of a CIED lead over or pinning a leaflet may be the main cause of TR in these patients.