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Effect of Leadless Pacemaker Implantation on Tricuspid Regurgitation
Scott D Eisenberg1, Bernard Evenhuis1, David R G Kulp1
1Emory University School of Medicine, Division of Internal Medicine, Atlanta, Georgia, USA.
Journal of Cardiovascular Electrophysiology
|June 2, 2026
Summary
Leadless pacemakers (LLPM) do not prevent tricuspid regurgitation (TR) progression. Worsening TR emerges after one year, suggesting a remodeling mechanism, while mitral regurgitation remains stable.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Leadless pacemakers (LLPM) eliminate trans-tricuspid leads, aiming to reduce tricuspid regurgitation (TR).
- Longitudinal data on LLPM impact on TR are limited.
Purpose of the Study:
- To evaluate the longitudinal impact of Micra LLPM implantation on TR severity.
- To assess changes in mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) post-LLPM.
Main Methods:
- Retrospective study of 356 patients with paired echocardiography before and after Micra implantation.
- TR and MR severity graded as none, mild, moderate, or severe.
- Analysis of TR at <1 year, 1-3 years, and >3 years postimplantation.
Main Results:
- TR worsened in 43.5% of patients over a median follow-up of 540 days.
- TR severity significantly increased at 1-3 years and beyond 3 years postimplantation (p<0.01).
- Severe TR proportion increased from 6.2% to 11.2%; LVEF declined modestly (p<0.001).
Conclusions:
- LLPM implantation is associated with progressive TR, with worsening emerging after the first year.
- The stability of MR suggests LLPM does not cause generalized valvular deterioration.
- Further research is needed to determine the clinical significance of LLPM-associated TR progression.
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