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Tricuspid incompetence following permanent pacemaker implantation
Marc Klutstein1, Jonathan Balkin, Adi Butnaru
1Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with Hebrew University of Jerusalem, Israel.
Pacing and Clinical Electrophysiology : PACE
|March 3, 2009
Summary
Worsening tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) is common, particularly in older patients with abnormal left ventricular relaxation and pulmonary hypertension. This study quantifies TI changes post-PPI.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Severe tricuspid insufficiency (TI) post-permanent pacemaker implantation (PPI) is a known complication, but its incidence remains unclear.
- Understanding the factors contributing to TI worsening after PPI is crucial for patient management.
Purpose of the Study:
- To determine the incidence and clinical correlates of worsening tricuspid insufficiency after permanent pacemaker implantation.
- To identify patient characteristics associated with significant TI progression post-PPI.
Main Methods:
- Retrospective analysis of 545 patients undergoing PPI with pre- and post-procedure Doppler echocardiograms.
- Exclusion of patients with moderate or severe TI prior to PPI.
- Categorization into groups based on the degree of TI worsening post-PPI.
Main Results:
- 18.3% of patients experienced a >2 grade worsening of TI after PPI.
- Older age (77 vs. 72 years) and abnormal mitral E/A ratio (0.98 vs. 1.42) were associated with greater TI worsening.
- Higher post-implantation systolic TI gradient observed in the group with significant TI worsening.
Conclusions:
- Worsening of tricuspid insufficiency after permanent pacemaker implantation is not rare.
- Older patients with abnormal left ventricular relaxation and those developing pulmonary hypertension are at higher risk for TI progression post-PPI.
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