Identification of Pacemaker Lead Position Using Fluoroscopy to Avoid Significant Tricuspid Regurgitation.

Area of Science:

• Cardiology
• Medical Devices
• Cardiac Electrophysiology

Background:

• Permanent pacemaker implantation enhances survival but poses risks.
• Tricuspid regurgitation (TR) is a known complication of pacemaker use.
• Lead impingement is the primary cause of pacemaker-mediated TR.

Purpose of the Study:

• To investigate the relationship between pacemaker lead location and tricuspid regurgitation.
• To identify specific lead positions associated with worsening TR and lead impingement.
• To assess the impact of lead impingement on TR severity.

Main Methods:

• Utilized fluoroscopy to assess pacemaker lead positions across the tricuspid annulus.
• Employed right anterior oblique (RAO) and left anterior oblique (LAO) views for lead evaluation.
• Performed 2D transthoracic echocardiography (TTE) to quantify TR severity.
• Used 3D TTE to visualize and confirm lead impingement.

Main Results:

• Worsening TR occurred in 23 out of 82 patients.
• Inferior RAO and septal LAO positions were most common.
• Mid-RAO and septal-LAO positions emerged as risk factors for lead impingement.
• These positions correlated with increased risks of significant TR and lead impingement.

Conclusions:

• Pacemaker-mediated TR is a significant clinical issue.
• Specific lead positions (mid-RAO, septal-LAO) increase the risk of impingement and TR.
• Optimizing lead placement may mitigate TR development.