Relationship between cardiac implantable electronic devices and tricuspid regurgitation in the general population

Cardiac implantable electronic devices (CIED) with right ventricular leads may mechanically restrict the tricuspid valve leaflets, leading to clinically relevant tricuspid regurgitation (TR).

This study aimed to examine the impact of CIED implantation on the development of new clinically relevant TR and tricuspid interventions in all Californians seeking inpatient or procedural care.

Using California's Department of Health Care Access and Information databases, a longitudinal Cox proportional-hazards analysis of adults who received care in an emergency department, hospital, or outpatient surgery facility from 1 October 2015 to 31 December 2020 was performed. Patients with rheumatic or congenital heart disease, endocarditis, and carcinoid were excluded. Outcomes were (1) the development of TR and (2) tricuspid intervention.

Of 16,889,936 patients contributing 54,650,137 person-years, there were 10,757 instances of TR over a median follow-up period of 3.55 years. In the unadjusted analyses, CIED implantation was associated with a 17-fold higher risk of incident TR. After adjusting for demographics and medical comorbidities, patients with a CIED exhibited a 65% higher risk of TR. Heart failure, pulmonary hypertension, hypertension, and atrial fibrillation each exhibited larger magnitudes of risk for TR than having a CIED. In the same population, 72 tricuspid valve interventions were identified. After multivariable adjustment, CIED implantation was associated with a 3-fold increased risk of tricuspid intervention.

Patients with a CIED experienced a higher risk of TR and tricuspid interventions, although the magnitude of the hazard was smaller than other cardiovascular risk factors.