Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation

• Published in: Journal of the American College of Cardiology Vol. 69; no. 18; pp. 2331 - 2341
• Main Authors: Chang, James D., MD, Manning, Warren J., MD, Ebrille, Elisa, MD, Zimetbaum, Peter J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 09-05-2017; Elsevier Limited
• Subjects: Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular diseases; Congenital diseases; Defibrillators; Defibrillators, Implantable - adverse effects; Device Removal; Diagnostic systems; echocardiography; Electronic devices; Electronic equipment; Heart; Heart diseases; Heart failure; Humans; implantable defibrillators; Implantation; Internal Medicine; Morbidity; Mortality; Patients; Postoperative Complications - etiology; Regurgitation; transvenous lead extraction; Tricuspid valve; Tricuspid Valve - anatomy & histology; Tricuspid Valve - physiology; tricuspid valve insufficiency; Tricuspid Valve Insufficiency - etiology; Tricuspid Valve Insufficiency - surgery; TV; RV; TTE; echocardiography; LV; PPM; TLE; tricuspid regurgitation; regurgitation; CIED; left ventricular; 3-dimensional; implantable cardioverter-defibrillator; transvenous lead extraction; heart failure; tricuspid valve; right ventricular; transthoracic echocardiography; ICD; implantable defibrillators; permanent pacemaker; 3D; TEE; transesophageal echocardiography; tricuspid valve insufficiency; TR; cardiac implantable electronic device
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.02.055

Abstract The potential for cardiac implantable electronic device leads to interfere with tricuspid valve (TV) function has gained increasing recognition as having hemodynamic and clinical consequences associated with incremental morbidity and death. The diagnosis and treatment of lead-related (as distinct from functional) tricuspid regurgitation pose unique challenges. Because of pitfalls in routine diagnostic imaging, a high level of clinical suspicion must be maintained to avoid overlooking the possibility that worsening heart failure is a consequence of mechanical interference with TV leaflet mobility or coaptation and is amenable to lead extraction or valve repair or replacement. The future of cardiac implantable electronic devices includes pacing and perhaps defibrillation without a lead traversing the TV.