Cardiac Implantable Electronic Device Lead-Induced Tricuspid Regurgitation

JACC Cardiovasc Imaging. 2019 Apr;12(4):622-636. doi: 10.1016/j.jcmg.2018.09.028.


With the expanding use of cardiac implantable electronic device (CIEDs) in an ever-aging population, the looming problem of CIED-associated interference with the tricuspid valve is significant. The first pacemaker was implanted in 1958 for severe symptomatic bradycardia. The concept of a device to avert sudden cardiac death (i.e., the defibrillator) was first published in 1970 by Mirowski and Mower. The first reports of CIED-mediated tricuspid valve apparatus interference surfaced in the late 1900s, but it was not until recently that concentrated efforts have been made to better define the scope of CIED-mediated interference with the tricuspid valve apparatus. Because stopping implantation of these devices is not an option, better understanding of their mechanical complications could potentially lead to improvements in device design or epicardial device implantation, as an alternative, in select patients. This review covers existing evidence for CIED-mediated tricuspid regurgitation, discusses potential mechanisms of CIED-mediated interference of the tricuspid valve apparatus, provides an overview of how to diagnose CIED-mediated interference on echocardiography, and discusses management strategies for patients who have CIED-mediated severe tricuspid regurgitation.

Keywords: 3D echocardiography; defibrillator; pacemaker; tricuspid regurgitation; tricuspid valve.

Publication types

  • Review
  • Video-Audio Media

MeSH terms

  • Cardiac Catheterization
  • Defibrillators, Implantable / adverse effects*
  • Device Removal
  • Diuretics / therapeutic use
  • Echocardiography
  • Heart Valve Prosthesis Implantation
  • Hemodynamics*
  • Humans
  • Pacemaker, Artificial / adverse effects*
  • Prosthesis Design
  • Risk Factors
  • Severity of Illness Index
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / physiopathology*
  • Tricuspid Valve Insufficiency / diagnostic imaging
  • Tricuspid Valve Insufficiency / etiology*
  • Tricuspid Valve Insufficiency / physiopathology
  • Tricuspid Valve Insufficiency / therapy


  • Diuretics