Assessment of the effects of cardiac rhythm device implantation on right sided heart function and tricuspid valve

Abstract

During our modern times, permanent pacemakers (PPMs) are commonly used devices for the treatment of many cardiac conduction disorders with an increasing rate. Although permanent cardiac pacing was introduced >50 years ago, and despite many technological advances, the transvenous implantation of endocardial leads remains the cornerstone of the procedure, which is considered an invasive procedure that is associated with several early and late complications. As it was noted during our search at this topic, the right ventricle had long been neglected as the left ventricle stole all the show from it, yet it is strongly associated with clinical outcomes in many conditions. Hence our study came to focus on the right side and tricuspid valve with evaluation of their function and effect of pacemaker leads on them. The reported frequency of developing significant TR following cardiac implantable electronic device (CIED) varies, showed wide variation. Initial studies using 2-dimensional (2D) echocardiography described conflicting results regarding the association between TR severity and the presence of a CIED. In this study we aimed to assess the effects of trans-tricuspid placement of permanent pacemaker (PPM), on the right sided heart function and tricuspid valve function in our cardiology department and to spot some light in this important clinical situation in our practice. In our study we found that permanent pacemaker implantation was associated with worsening of TR. TR was increased by at least one grade in 28 percent of patients, 25% of patients increased by one grade, (16% changed from trace/none to mild, 9% from mild to moderate) and 3 percent of patients by 2 grades from trace to moderate. However other parameters as LVEF, RV size, TAPSE, E/A ratio, RVSP showed no significant change.