Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

• Published in: PloS one Vol. 15; no. 6; p. e0235230
• Main Authors: Seo, Jiwon, Kim, Dae-Young, Cho, Iksung, Hong, Geu-Ru, Ha, Jong-Won, Shim, Chi Young
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 26.06.2020; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Care and treatment; Confidence intervals; Congestive heart failure; Echocardiography; Engineering and Technology; Fibrillation; Heart failure; Heart surgery; Hospitals; Implantation; Lead; Medical prognosis; Medical schools; Medicine; Medicine and Health Sciences; Pacemakers; Patient outcomes; Patients; Prognosis; Ratios; Regression analysis; Regurgitation; Research and Analysis Methods; Statistical analysis; Surgery; Surgical implants; Tricuspid valve; Tricuspid valve insufficiency; Variance analysis; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235230

This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27-4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68-6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43-4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.