Effects of Implantable Cardioverter-Defibrillator Leads on the Tricuspid Valve and Right Ventricle: A Randomized Trial

• Published in: JACC. Clinical electrophysiology Vol. 10; no. 9; p. 2088
• Main Authors: Leong, Darryl P, Dokainish, Hisham, Mondésert, Blandine, Cavalli, Germano, Khetan, Aditya, Cirne, Filipe, Baro Vila, Rocio, Klimis, Harry, De Jesus, Tais Araujo, AlGhasab, Naif Saad, Akbari, Vahid, Suliman, Asem, Eltebi, Osama, Almhri, Ali, Ferdous, Tahsin, Djuric, Angie, Bashir, Jamil, Krahn, Andrew D, Exner, Derek V, Philippon, François, Birne, David H, Joza, Jacqueline, Healey, Jeff S
• Format: Journal Article
• Language: English
• Published: United States 01-09-2024
• Subjects: Adult; Aged; Defibrillators, Implantable - adverse effects; Echocardiography; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; Middle Aged; Tricuspid Valve - diagnostic imaging; Tricuspid Valve Insufficiency; tricuspid regurgitation; right ventricular; cardiovascular implantable electronic device; implantable cardioverter-defibrillator; lead
• ISSN: 2405-5018; 2405-5018
• DOI: 10.1016/j.jacep.2024.04.034

There are no randomized data to inform the extent to which transvenous cardiac leads cause tricuspid regurgitation (TR).
This study sought to determine the effect of a transvenous implantable cardioverter-defibrillator (TV-ICD) on TR severity, and secondarily, on right ventricular (RV) size and function.
We evaluated TR severity before and 6 months after implantable cardioverter-defibrillator insertion in a post hoc analysis of adults randomized to receive a transvenous (n = 252) or subcutaneous implantable cardioverter-defibrillator (S-ICD) (n = 251) device. TR and RV size and systolic function were assessed by echocardiographic images analyzed in a core laboratory.
At baseline, at least mild TR was present in 30% of individuals. At 6 months, the proportion of participants with any TR in the TV-ICD group was 42% vs 19% in the S-ICD group (P < 0.001). The proportion with moderate or severe TR was 7% in the TV-ICD group vs 2% in the S-ICD group (P = 0.021). At 6 months, the OR of at least 1 grade worsening of TR in the TV-ICD group as compared with the S-ICD group was 7.2 (95% CI: 3.3-15.8; P < 0.001). There were no differences between groups with respect to RV size or systolic function.
Six months following TV-ICD insertion, there was a 7-fold increase in the risk of at least 1 grade worsening of TR, with 7% of individuals having TR that was moderate or severe. There was no detectable difference in RV size or function; however, longer follow-up is needed.