Incidence and Predictors of Acute Tricuspid Regurgitation Worsening After Left Bundle Branch Area Pacing

Worsening of tricuspid regurgitation (TR) has been recognized after transvenous cardiac implantable electronic device implantation, but data on early echocardiographic TR deterioration after left bundle branch area pacing (LBBAP) remain limited.

We retrospectively studied 239 consecutive patients who underwent successful LBBAP and transthoracic echocardiography before and within 1 week after implantation. TR severity was graded on a 5-point scale, and acute worsening was defined as an increase of ≥1 grade. Lead-to-tricuspid valve distance was measured echocardiographically, and lead type was classified as lumenless or stylet-driven. Acute TR worsening occurred in 27 patients (11.3%). The incidence of worsening did not differ between lumenless and stylet-driven leads (6/54 [11.1%] vs. 21/185 [11.4%], P=1.00). Median TR grade did not significantly change between baseline and early postprocedural assessment (1 [1-2] vs. 1 [1-2], P=0.29), but TR peak pressure gradient and estimated right ventricular systolic pressure decreased in paired analyses. In the multivariable analysis, atrial fibrillation (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.04-5.42, P=0.041) and shorter lead-to-tricuspid valve distance (per 1-mm increase: OR 0.91, 95% CI 0.85-0.98, P=0.007) were independently associated with acute worsening.

Acute TR worsening occurred in approximately 1 in 10 patients after LBBAP. Atrial fibrillation and shorter lead-to-tricuspid valve distance, but not lead type, were independently associated with early TR deterioration.