Impact of implantable transvenous device lead location on severity of tricuspid regurgitation.
BACKGROUND
Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR.


METHODS
A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis.


RESULTS
Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively.


CONCLUSION
Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.
['Addetia|Karima|K|', 'Maffessanti|Francesco|F|', 'Mediratta|Anuj|A|', 'Yamat|Megan|M|', 'Weinert|Lynn|L|', 'Moss|Joshua D|JD|', 'Nayak|Hemal M|HM|', 'Burke|Martin C|MC|', 'Patel|Amit R|AR|', 'Kruse|Eric|E|', 'Jeevanandam|Valluvan|V|', 'Mor-Avi|Victor|V|', 'Lang|Roberto M|RM|']
D000328:Adult D000368:Aged D004452:Echocardiography D004567:Electrodes, Implanted D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012680:Sensitivity and Specificity D012720:Severity of Illness Index D014262:Tricuspid Valve Insufficiency D014680:Veins D018487:Ventricular Dysfunction, Left
Tricuspid regurgitation Intracardiac defibrillator Pacemaker Three-dimensional echocardiography