Tricuspid Valve Regurgitation Following Stylet Lumen-Less Active Fixation Lead or Leadless Pacemaker Implantation

Tricuspid valve regurgitation (TR) progression is a recognized complication of cardiac-implantable electronic devices. Implanting a leadless pacemaker (LLPM) or using a 4.1Fr stylet lumen-less transvenous lead may lower the risk of TR progression compared to conventional 5-7Fr transvenous leads; however, the optimal strategy remains unclear. This study aimed to evaluate TR progression following those two approaches.

A retrospective comparison was conducted between patients receiving an LLPM (n = 27) and those implanted with a 4.1Fr transvenous right ventricular lead (n = 190). The primary outcome was the prevalence of significant TR, defined as moderate or severe TR, at 12 months post-implantation. The secondary outcome was the incidence of TR progression, defined as a worsening of ≥1 grade between baseline and 12 months post-implantation.

Baseline TR severity did not differ significantly between the two groups. At the 12-month follow-up, the prevalence of significant TR remained comparable between the LLPM and 4.1Fr lead groups (15% vs. 12%, p = 0.54). While most patients in both groups experienced either no change or a one-grade worsening in TR severity, the LLPM group demonstrated a significantly higher incidence of TR progression compared to the 4.1Fr lead group (33% vs. 16%, p = 0.034). Multivariate analysis identified left ventricular ejection fraction <50% as an independent predictor of TR progression (odds ratio 3.05, 95% confidence interval 1.08-8.61, p = 0.036).

Implantation of a 4.1Fr lead in the right ventricular septum may be an optimal strategy to minimize the risk of TR progression following pacemaker implantation.