Deterioration of Chronic Heart Failure Due to Lead-Associated Tricuspid Regurgitation



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Implantable intracardiac devices, including permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy systems, have become an integral part of clinical practice and have demonstrated their effectiveness in improving prognosis in patients with bradyarrhythmias, high risk of sudden cardiac death, and chronic heart failure (CHF). However, with the growing number of device implantations, increasing attention is being paid to long-term complications, particularly tricuspid regurgitation (TR) associated with intracardiac leads.

It has been shown that lead-associated TR may be linked to worsening of heart failure symptoms, increased frequency of hospitalizations, and reduced survival. Nevertheless, the pathophysiological mechanisms of this condition, its clinical course, and diagnostic approaches remain insufficiently standardized. Furthermore, current clinical guidelines lack clear algorithms for the management of such cases. According to the literature, the reported prevalence of TR following lead implantation ranges from 7% to 39%, reflecting the heterogeneity of studies and the absence of unified diagnostic criteria. This significantly complicates the assessment of the true prevalence and clinical relevance of this complication. Additional challenges arise in selecting an appropriate treatment strategy, particularly regarding the decision for transvenous lead extraction or surgical correction.

Therefore, an individualized and multidisciplinary approach is required for each patient, as well as further research aimed at developing consistent clinical guidelines.

Full Text

Restricted Access

About the authors

Elizaveta Kotlyarevskaya

Pirogov Russian National Research Medical University

Author for correspondence.
Email: doctor.liza999@gmail.com
ORCID iD: 0009-0003-2918-9804

Resident physician, Department of Hospital Therapy named after G.I. Storozhakov

Russian Federation, Moscow, Russia, 117997, Ostrovityanova St., 1

Rim Albertovich Sadrutdinov

City Clinical Hospital No. 24, Moscow Health Department

Email: sadrutdinovrimalbertovic@gmail.com
ORCID iD: 0009-0003-1344-6941

Anesthesiologist-resuscitator, Head of the Intensive Care Unit, City Clinical Hospital No. 24, Moscow Health Department

Russian Federation, Moscow, Russia, 127015, Pistsovaya St., 10 bld. 2

Elnara Ferrukhovna Dadashova

City Clinical Hospital No. 24, Moscow Health Department

Email: elnaraferruhovnadadasova@gmail.com
ORCID iD: 0009-0003-3324-3957

Cardiologist, City Clinical Hospital No. 24, Moscow Health Department

Russian Federation, Moscow, Russia, 127015, Pistsovaya St., 10 bld. 2

Azamat Maratovich Baymukanov

City Clinical Hospital named after V.M. Buyanov, Moscow Health Department

Email: baymukanov@gmail.com
ORCID iD: 0000-0003-0438-8981

Candidate of Medical Sciences, Cardiologist, Department of Surgical Treatment of Complex Cardiac Arrhythmias and Electrocardiostimulation, City Clinical Hospital named after V.M. Buyanov, Moscow Health Department

Russian Federation, Moscow, Russia, 115516, Bakinskaya St., 26

Alexander Romanovich Katanaev

City Clinical Hospital No. 24, Moscow Health Department

Email: katanaevaaleksandr8@gmail.com
ORCID iD: 0009-0009-0052-297X

Anesthesiologist-resuscitator, City Clinical Hospital No. 24, Moscow Health Department

Russian Federation, Moscow, Russia, 127015, Pistsovaya St., 10 bld. 2

Artem Vladimirovich Snitsar

City Clinical Hospital No. 24, Moscow Health Department

Email: snitsar@gmail.com
ORCID iD: 0000-0001-6053-4651

Cardiovascular surgeon, Chief Physician, City Clinical Hospital No. 24, Moscow Health Department

Russian Federation, Moscow, Russia, 127015, Pistsovaya St., 10 bld. 2

Zaur Feliksovich Misikov

City Clinical Hospital No. 24, Moscow Health Department

Email: misikov-zf@rudn.ru
ORCID iD: 0009-0001-3366-7157

Anesthesiologist-resuscitator, head of the resuscitation and intensive care department, City Clinical Hospital No. 24, Moscow Health Department

Russian Federation, Moscow, Russia, 127015, Pistsovaya St., 10 bld. 2

Gennady Efimovich Gendlin

Pirogov Russian National Research Medical University

Email: RGMUGT2@mail.ru
ORCID iD: 0000-0002-7846-1611

Doctor of Medical Sciences, Professor of the Department of Hospital Therapy named after G.I. Storozhakov, Institute of Clinical Medicine, Pirogov Russian National Research Medical University

Russian Federation, Moscow, Russia, 117997, Ostrovityanova St., 1

References

  1. Al-Mohaissen MA, Chan KL. Prevalence and Mechanism of Tricuspid Regurgitation following Implantation of Endocardial Leads for Pacemaker or Cardioverter-Defibrillator. Journal of the American Society of Echocardiography. 2012;25(3):245-252. doi: 10.1016/j.echo.2011.11.020
  2. Vieitez JM, Monteagudo JM, Mahia P, et al. New insights of tricuspid regurgitation: a large-scale prospective cohort study. Eur Heart J Cardiovasc Imaging. 2021;22(2):196-202. doi: 10.1093/ehjci/jeaa205
  3. Tatum R, Maynes EJ, Wood CT, et al. Tricuspid regurgitation associated with implantable electrical device insertion: A systematic review and meta‐analysis. Pacing and Clinical Electrophysiology. 2021;44(8):1297-1302. doi: 10.1111/pace.14287
  4. Offen S, Strange G, Playford D, et al. Prevalence and prognostic impact of tricuspid regurgitation in patients with cardiac implantable electronic devices: From the national echocardiography database of Australia. Int J Cardiol. 2023;370:338-344. doi: 10.1016/j.ijcard.2022.10.160
  5. Van De Heyning CM, Elbarasi E, Masiero S, et al. Prospective Study of Tricuspid Regurgitation Associated With Permanent Leads After Cardiac Rhythm Device Implantation. Canadian Journal of Cardiology. 2019;35(4):389-395. doi: 10.1016/j.cjca.2018.11.014
  6. Andreas M, Burri H, Praz F, et al. Tricuspid valve disease and cardiac implantable electronic devices. Eur Heart J. 2024;45(5):346-365. doi: 10.1093/eurheartj/ehad783
  7. Aldaas OM, Ma G, Bui Q, et al. Tricuspid Regurgitation in the Setting of Cardiac Implantable Electronic Devices. Structural Heart. 2025;9(1):100319. doi: 10.1016/j.shj.2024.100319
  8. Hussein AA, Wilkoff BL. Lead Extraction Considerations for the Referring Cardiologist. Cardiol Rev. 2017;25(1):17-21. doi: 10.1097/CRD.0000000000000130
  9. Addetia K, Harb SC, Hahn RT, et al. Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation. JACC Cardiovasc Imaging. 2019;12(4):622-636. doi: 10.1016/j.jcmg.2018.09.028
  10. Lin G, Nishimura RA, Connolly HM, et al. Severe Symptomatic Tricuspid Valve Regurgitation Due to Permanent Pacemaker or Implantable Cardioverter-Defibrillator Leads. J Am Coll Cardiol. 2005;45(10):1672-1675. doi: 10.1016/j.jacc.2005.02.037
  11. Saito M, Kaye G, Negishi K, et al. Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing. Heart. 2015;101(8):600-608. doi: 10.1136/heartjnl-2014-306990
  12. AL‐BAWARDY R, KRISHNASWAMY A, RAJESWARAN J, et al. Tricuspid Regurgitation and Implantable Devices. Pacing and Clinical Electrophysiology. 2015;38(2):259-266. doi: 10.1111/pace.12530
  13. Fanari Z, Hammami S, Hammami MB, et al. The effects of right ventricular apical pacing with transvenous pacemaker and implantable cardioverter defibrillator on mitral and tricuspid regurgitation. J Electrocardiol. 2015;48(5):791-797. doi: 10.1016/j.jelectrocard.2015.07.002
  14. LEE RC, FRIEDMAN SE, KONO AT, et al. Tricuspid Regurgitation Following Implantation of Endocardial Leads: Incidence and Predictors. Pacing and Clinical Electrophysiology. 2015;38(11):1267-1274. doi: 10.1111/pace.12701
  15. Delling FN, Hassan ZK, Piatkowski G, et al. Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads. Am J Cardiol. 2016;117(6):988-992. doi: 10.1016/j.amjcard.2015.12.038
  16. Beurskens NEG, Tjong FVY, de Bruin-Bon RHA, et al. Impact of Leadless Pacemaker Therapy on Cardiac and Atrioventricular Valve Function Through 12 Months of Follow-Up. Circ Arrhythm Electrophysiol. 2019;12(5). doi: 10.1161/CIRCEP.118.007124
  17. Nakajima H, Seo Y, Ishizu T, et al. Features of Lead-Induced Tricuspid Regurgitation in Patients With Heart Failure Events After Cardiac Implantation of Electronic Devices ― A Three-Dimensional Echocardiographic Study ―. Circulation Journal. 2020;84(12):2302-2311. doi: 10.1253/circj.CJ-20-0620
  18. Kanawati J, Ng ACC, Khan H, et al. Long-Term Follow-Up of Mortality and Heart Failure Hospitalisation in Patients With Intracardiac Device-Related Tricuspid Regurgitation. Heart Lung Circ. 2021;30(5):692-697. doi: 10.1016/j.hlc.2020.08.028
  19. Nemoto N, Lesser JR, Pedersen WR, et al. Pathogenic structural heart changes in early tricuspid regurgitation. J Thorac Cardiovasc Surg. 2015;150(2):323-330. doi: 10.1016/j.jtcvs.2015.05.009
  20. Mediratta A, Addetia K, Yamat M, et al. 3D Echocardiographic Location of Implantable Device Leads and Mechanism of Associated Tricuspid Regurgitation. JACC Cardiovasc Imaging. 2014;7(4):337-347. doi: 10.1016/j.jcmg.2013.11.007
  21. Gelves-Meza J, Lang RM, Valderrama-Achury MD, et al. Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review. Journal of the American Society of Echocardiography. 2022;35(11):1107-1122. doi: 10.1016/j.echo.2022.08.004
  22. Svennberg E, Jacobs K, McVeigh E, et al. Computed Tomography–Guided Risk Assessment in Percutaneous Lead Extraction. JACC Clin Electrophysiol. 2019;5(12):1439-1446. doi: 10.1016/j.jacep.2019.09.007
  23. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-3520. doi: 10.1093/eurheartj/ehab364
  24. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227. doi: 10.1161/CIR.0000000000000923
  25. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi: 10.1093/eurheartj/ehab395
  26. Bongiorni MG, Burri H, Deharo JC, et al. 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. EP Europace. 2018;20(7):1217-1217. doi: 10.1093/europace/euy050
  27. Park SJ, Gentry JL, Varma N, et al. Transvenous Extraction of Pacemaker and Defibrillator Leads and the Risk of Tricuspid Valve Regurgitation. JACC Clin Electrophysiol. 2018;4(11):1421-1428. doi: 10.1016/j.jacep.2018.07.011
  28. Polewczyk A, Jacheć W, Nowosielecka D, et al. Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis. J Clin Med. 2021;11(1):89. doi: 10.3390/jcm11010089
  29. Saran N, Said SM, Schaff H V., et al. Outcome of tricuspid valve surgery in the presence of permanent pacemaker. J Thorac Cardiovasc Surg. 2018;155(4):1498-1508.e3. doi: 10.1016/j.jtcvs.2017.11.093
  30. Pfannmueller B, Hirnle G, Seeburger J, et al. Tricuspid valve repair in the presence of a permanent ventricular pacemaker lead. European Journal of Cardio-Thoracic Surgery. 2011;39(5):657-661. doi: 10.1016/j.ejcts.2010.08.051
  31. PFANNMUELLER B, BUDDE LM, ETZ CD, et al. Mid-term results after isolated tricuspid valve surgery in the presence of right ventricular leads. J Cardiovasc Surg (Torino). 2021;62(5). doi: 10.23736/S0021-9509.21.11803-8
  32. Latib A, Mangieri A. Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol. 2017;69(14):1807-1810. doi: 10.1016/j.jacc.2017.02.016
  33. Taramasso M, Maisano F. Novel Technologies for percutaneous treatment of tricuspid valve regurgitation. Eur Heart J. 2017;38(36):2707-2710. doi: 10.1093/eurheartj/ehx475
  34. Sorajja P, Whisenant B, Hamid N, et al. Transcatheter Repair for Patients with Tricuspid Regurgitation. New England Journal of Medicine. 2023;388(20):1833-1842. doi: 10.1056/NEJMoa2300525
  35. Arnold S V., Goates S, Sorajja P, et al. Health Status After Transcatheter Tricuspid-Valve Repair in Patients With Severe Tricuspid Regurgitation. J Am Coll Cardiol. 2024;83(1):1-13. doi: 10.1016/j.jacc.2023.10.008
  36. Belott P, Reynolds D. Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation in Adults. In: Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy. Elsevier; 2017:631-691. doi: 10.1016/B978-0-323-37804-8.00026-2
  37. Noheria A, van Zyl M, Scott LR, et al. Single-site ventricular pacing via the coronary sinus in patients with tricuspid valve disease. EP Europace. 2018;20(4):636-642. doi: 10.1093/europace/euw422
  38. El-Chami MF, Al-Samadi F, Clementy N, et al. Updated performance of the Micra transcatheter pacemaker in the real-world setting: A comparison to the investigational study and a transvenous historical control. Heart Rhythm. 2018;15(12):1800-1807. doi: 10.1016/j.hrthm.2018.08.005

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия  ПИ № ФС 77 - 86296 от 11.12.2023 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80632 от 15.03.2021 г.