Change in Tricuspid Valve Function After Transvenous Lead Extraction, Predisposing Factors and Prognostic Roles

Overview

Journal Rev Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 30

PMID 39076327

Authors

Wojciech Jachec

Anna Polewczyk

Dorota Nowosielecka

Andrzej Tomaszewski

Wojciech Brzozowski

Dorota Szczesniak-Stanczyk

Krzysztof Duda

Agnieszka Nowosielecka

Andrzej Kutarski

Affiliations

Soon will be listed here.

Abstract

Background: Changes in tricuspid valve (TV) function following transvenous lead extraction (TLE) and their impact on long-term survival have not yet been investigated.

Methods: From 3633 patients undergoing lead extraction between 2006 and 2021, TV function before and after TLE was evaluated in 2693 patients.

Results: After TLE, the TV function remained unchanged in 82.36% of patients, worsened in 9.54%, and improved in 8.10%. Abandoned leads (odds ratio, OR = 1.712; 0.044), fibrotic adhesions between leads and TV apparatus (OR = 3.596; 0.001), or right ventricular wall (OR = 2.478; 0.001) were predisposed to TV worsening. Non-infectious indications for TLE (OR = 1.925; 0.001), the severity of tricuspid valve regurgitation (TVR) before TLE (OR = 3.125; 0.001), and lead encapsulation (OR = 2.159; 0.001) were predictors of improvement in TV function. Although either worsening or improving TV function had no impact on long-term survival in all patients, decreased TVR severity in the subgroup of patients with initial regurgitation grades 3-4 was associated with a better prognosis (hazard ratio, HR = 0.622; 0.005).

Conclusions: 1. Changes in TV function after TLE were observed in 17.64% of patients. 2. Various factors can predispose to lead-related TV changes, although the common denominator in these events is an extensive buildup of scar tissue. 3. Worsening TV function had no impact on survival after TLE. In patients with severe TV dysfunction, reduction in TVR following TLE was associated with a 40% reduction in mortality during a mean follow-up of 1673 days.

References

Franceschi F, Thuny F, Giorgi R, Sanaa I, Peyrouse E, Assouan X . Incidence, risk factors, and outcome of traumatic tricuspid regurgitation after percutaneous ventricular lead removal. J Am Coll Cardiol. 2009; 53(23):2168-74. DOI: 10.1016/j.jacc.2009.02.045. View

Al-Mohaissen M, Chan K . Prevalence and mechanism of tricuspid regurgitation following implantation of endocardial leads for pacemaker or cardioverter-defibrillator. J Am Soc Echocardiogr. 2012; 25(3):245-52. DOI: 10.1016/j.echo.2011.11.020. View

Park S, Gentry 3rd J, Varma N, Wazni O, Tarakji K, Mehta A . Transvenous Extraction of Pacemaker and Defibrillator Leads and the Risk of Tricuspid Valve Regurgitation. JACC Clin Electrophysiol. 2018; 4(11):1421-1428. DOI: 10.1016/j.jacep.2018.07.011. View

Kusumoto F, Schoenfeld M, Wilkoff B, Berul C, Birgersdotter-Green U, Carrillo R . 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14(12):e503-e551. DOI: 10.1016/j.hrthm.2017.09.001. View

Kutarski A, Jachec W, Tulecki L, Czajkowski M, Nowosielecka D, Stefanczyk P . Disparities in transvenous lead extraction in young adults. Sci Rep. 2022; 12(1):9601. PMC: 9187694. DOI: 10.1038/s41598-022-13769-y. View

Iskandar S, Ann Jackson S, Fahrig S, Mechleb B, Garcia I . Tricuspid valve malfunction and ventricular pacemaker lead: case report and review of the literature. Echocardiography. 2006; 23(8):692-7. DOI: 10.1111/j.1540-8175.2006.00289.x. View

Wen-Zong L, Liang M . Severe tricuspid valve regurgitation due to perforation by permanent pacemaker lead. J Card Surg. 2011; 26(5):555-6. DOI: 10.1111/j.1540-8191.2011.01285.x. View

Coffey J, Sager S, Gangireddy S, Levine A, Viles-Gonzalez J, Fischer A . The impact of transvenous lead extraction on tricuspid valve function. Pacing Clin Electrophysiol. 2013; 37(1):19-24. DOI: 10.1111/pace.12236. View

Fazio S, Carlomagno G . The importance of tricuspid regurgitation and right ventricular overload in ICD/CRT recipients: beside the left, beyond the left. Pacing Clin Electrophysiol. 2011; 34(10):1181-4. DOI: 10.1111/j.1540-8159.2011.03189.x. View

10.

Nowosielecka D, Jachec W, Polewczyk A, Tulecki L, Kleinrok A, Kutarski A . Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction. Int J Environ Res Public Health. 2021; 18(4). PMC: 7918219. DOI: 10.3390/ijerph18041862. View

11.

Webster G, Margossian R, Alexander M, Cecchin F, Triedman J, Walsh E . Impact of transvenous ventricular pacing leads on tricuspid regurgitation in pediatric and congenital heart disease patients. J Interv Card Electrophysiol. 2007; 21(1):65-8. PMC: 4260457. DOI: 10.1007/s10840-007-9183-0. View

12.

Kim J, Spevack D, Tunick P, Bullinga J, Kronzon I, Chinitz L . The effect of transvenous pacemaker and implantable cardioverter defibrillator lead placement on tricuspid valve function: an observational study. J Am Soc Echocardiogr. 2007; 21(3):284-7. DOI: 10.1016/j.echo.2007.05.022. View

13.

Celiker C, Kucukoglu M, Arat-Ozkan A, Yazicioglu N, Uner S . Right ventricular and tricuspid valve function in patients with two ventricular pacemaker leads. Jpn Heart J. 2004; 45(1):103-8. DOI: 10.1536/jhj.45.103. View

14.

Taira K, Suzuki A, Fujino A, Watanabe T, Ogyu A, Ashikawa K . Tricuspid valve stenosis related to subvalvular adhesion of pacemaker lead: a case report. J Cardiol. 2006; 47(6):301-6. View

15.

Seo J, Kim D, Cho I, Hong G, Ha J, Shim C . Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation. PLoS One. 2020; 15(6):e0235230. PMC: 7319337. DOI: 10.1371/journal.pone.0235230. View

16.

Assayag P, Thuaire C, Benamer H, Sebbah J, Leport C, Brochet E . Partial rupture of the tricuspid valve after extraction of permanent pacemaker leads: detection by transesophageal echocardiography. Pacing Clin Electrophysiol. 1999; 22(6 Pt 1):971-4. DOI: 10.1111/j.1540-8159.1999.tb06828.x. View

17.

Wilkoff B, Love C, Byrd C, Bongiorni M, Carrillo R, Crossley 3rd G . Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm. 2009; 6(7):1085-104. DOI: 10.1016/j.hrthm.2009.05.020. View

18.

Deharo J, Bongiorni M, Rozkovec A, Bracke F, Defaye P, Fernandez-Lozano I . Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper. Europace. 2011; 14(1):124-34. DOI: 10.1093/europace/eur338. View

19.

Cori A, Auricchio A, Regoli F, Blomstrom-Lundqvist C, Butter C, Dagres N . Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry. Europace. 2019; 21(7):1096-1105. DOI: 10.1093/europace/euz062. View

20.

Givon A, Vedernikova N, Luria D, Vatury O, Kuperstein R, Feinberg M . Tricuspid Regurgitation following Lead Extraction: Risk Factors and Clinical Course. Isr Med Assoc J. 2016; 18(1):18-22. View