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Breeman KTN, Peijster AJL, De Bruin-Bon HACM, Pepplinkhuizen S, Van der Stuijt W, De Veld JA, Beurskens NEG, Stuiver MM, Wilde AAM, Tjong FVY, Knops RE. Worsening tricuspid regurgitation after ICD implantation is rather due to transvenous lead than natural progression. Int J Cardiol 2023; 376:76-80. [PMID: 36758860 DOI: 10.1016/j.ijcard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Transvenous implantable cardioverter-defibrillators (TV-ICDs) are associated with greater tricuspid regurgitation (TR) severity, which leads to increased mortality. The pathophysiology is assumed to be lead-related, hence, treatment includes lead extraction. However, TR may also naturally occur in the high-risk ICD population, or may be caused by right ventricular pacing. We sought to evaluate the effect of ICD type (with or without lead) and pacing percentage on post-implantation TR severity. METHODS In this retrospective cohort study, consecutive patients were included with a primary S-ICD or TV-ICD implantation between 2009 and 2019 and echocardiography studies ≤3 months before and ≤ 3 years post-implantation. The effect of ICD type on TR severity at follow-up was estimated adjusting for ventricular pacing percentage and potential confounders. The effect of ventricular pacing percentage on TR severity at follow-up was adjusted for potential confounders. RESULTS 118 patients were included (mean age 52 ± 21): 31 (26%) with an S-ICD and 87 (74%) with a TV-ICD. Median 20 months post-implantation, worsening TR was found in 11/31 (34%) S-ICD patients and 45/87 (52%) TV-ICD patients (p = 0.15). Adjusted for age, atrial fibrillation, baseline TR and mitral regurgitation, ventricular pacing percentage, ICD dwelling time, BMI, hypertension and left ventricular ejection fraction, TV-ICDs were significantly associated with greater TR severity (OR 9.90, p = 0.002). Ventricular pacing percentage was very low, and not significantly associated with greater TR severity (OR 0.95, p = 0.066). CONCLUSIONS Our results suggest that greater TR severity in ICD patients is mainly caused by the transvenous lead, rather than natural progression in the ICD population.
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Affiliation(s)
- K T N Breeman
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands.
| | - A J L Peijster
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - H A C M De Bruin-Bon
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - S Pepplinkhuizen
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - W Van der Stuijt
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - J A De Veld
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - N E G Beurskens
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - M M Stuiver
- Amsterdam UMC location University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Meibergdreef 9, Amsterdam, the Netherlands
| | - A A M Wilde
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - F V Y Tjong
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
| | - R E Knops
- Amsterdam UMC location University of Amsterdam, Heart Centre, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, the Netherlands
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