In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
Abstract:
Introduction: Transvenous implantable cardioverter-defibrillators (TV-ICDs) are associated with greater tricuspid regurgitation (TR) severity, which leads to increased mortality. The pathophysiology is often assumed to be lead-related, hence, treatment includes lead extraction and alternative defibrillation strategies. However, TR may also be naturally occurring in the ICD population with a high risk of secondary TR, or may be caused by right ventricular pacing. Purpose: We aimed to evaluate the effect of ICD type (with or without lead) and pacing percentage on post-implantation TR severity. Methods: In this retrospective cohort study, we included consecutive patients with a first S-ICD or TV-ICD implantation between December 2009 until December 2019 and who underwent an echocardiography study ≤3 months before and ≤3 years post-implantation. TR severity at follow-up was adjusted for potential confounders using ordinal regression analysis. Results: 118 patients were included (mean age 52±21; 29% female), of whom 31 (26%) with an S-ICD and 87 (74%) with a TV-ICD. Follow-up echocardiography was performed median 20 months (IQR 14-29 months) after implantation. Worsening TR between pre- and post-implantation echocardiography was found in 11/31 (34%) patients with an S-ICD and 45/87 (52%) patients with a TV-ICD (p=0.15). Adjusted for age, atrial fibrillation, baseline TR and mitral regurgitation, ventricular pacing percentage and time since ICD implantation, TV-ICDs were significantly associated with greater TR severity at follow-up (OR 8.38, p=0.002). Ventricular pacing percentage was very low (5/118 [4%] were paced 〉 10%), and not significantly associated with greater TR severity (OR 0.97, p=0.123). Conclusions: Our results suggest that greater TR severity in ICD patients is mainly caused by the transvenous lead, rather than natural progression in the ICD population.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.146.suppl_1.12453
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
1466401-X
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