Tricuspid incompetence following permanent pacemaker implantation

Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S135-7. doi: 10.1111/j.1540-8159.2008.02269.x.

Abstract

Aim: Severe tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) has been described in small series of patients, though its incidence is not known.

Methods: We retrospectively analyzed the data of 545 patients who underwent PPI and had Doppler echocardiograms performed before and after the procedure. We excluded 135 patients who had > or =moderate TI on the 1st Doppler echocardiogram.

Results: Group 1 included 75 patients (18.3%) who had a >2 grades worsening of TI, and group 2 included 335 patients (82%) with <2 grade increase in TI after PPI. Patients in group 1 were 77 +/- 7 years of age, versus 72 +/- 10 years in group 2 (P < 0.001). There was no difference in left ventricular size and function. The TI gradient before PPI was higher in group 2 (25 +/- 13 mmHg versus 19 +/- 12 mmHg [P < 0.001]), though within the normal range in both groups. The mitral E/A ratio was 0.98 in group 1 versus 1.42 in group 2 (P < 0.001). The systolic TI gradient after implantation was 42 +/- 12 mmHg in group 1, versus 33 +/- 8 mmHg in group 2 (P < 0.001).

Conclusion: Worsening of TI after PPI was not rare and was observed more often in older patients, with abnormal LV relaxation and who developed pulmonary hypertension after the procedure.

MeSH terms

  • Aged
  • Female
  • Humans
  • Incidence
  • Israel / epidemiology
  • Male
  • Pacemaker, Artificial / adverse effects*
  • Pacemaker, Artificial / statistics & numerical data*
  • Prostheses and Implants / statistics & numerical data*
  • Prosthesis Failure
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Tricuspid Valve Insufficiency / diagnosis
  • Tricuspid Valve Insufficiency / epidemiology*
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / epidemiology*