Vaturi Mordehay, Kusniec Jairo, Shapira Yaron, Nevzorov Roman, Yedidya Idit, Weisenberg Daniel, Monakier Daniel, Strasberg Boris, Sagie Alexander
Rabin Medical Center, Beilinson Hospital, 36 Jabotinsky Street, Petach Tikva 49100, Israel.
Eur J Echocardiogr. 2010 Jul;11(6):550-3. doi: 10.1093/ejechocard/jeq018. Epub 2010 Feb 25.
The effect of right ventricular (RV) pacing on tricuspid regurgitation (TR) is debatable and is presumed to be related to an interference with valve closure by the electrode. The aim of the study was to determine the impact of pacing per se on TR grade.
The study group included 23 clinically stable patients (13 males; mean age 78 +/- 12 years) with a permanent pacemaker at the RV apex (83% DDD mode) and normal left ventricular function. They were all non-dependent on pacing and were otherwise in sinus rhythm. None had a primary dysfunction of the tricuspid valve. TR grade and RV size were assessed in two consecutive echo studies with and without active RV pacing. Results showed that active RV pacing was associated with an increase in TR severity (TR vena contracta: 0.4 +/- 0.2 vs. 0.2 +/- 0.2 cm, P < 0.001; TR jet area: 4.1 +/- 2.3 vs. 2.3 +/- 1.8 cm(2), P < 0.001). This was also reflected in a significant decrease in the number of patients with mild TR (P = 0.003) and increase in the number with moderate regurgitation (P = 0.02). There was no change in RV areas with pacing.
Active RV pacing is associated with a significant increase in TR grade. This effect is not induced by acute changes in the RV area and is unrelated to an interference with leaflet closure by the electrode.
右心室（RV）起搏对三尖瓣反流（TR）的影响存在争议，推测与电极干扰瓣膜关闭有关。本研究的目的是确定起搏本身对TR分级的影响。
研究组包括23例临床稳定的患者（13例男性；平均年龄78±12岁），他们在RV心尖部植入了永久起搏器（83%为DDD模式）且左心室功能正常。他们均不依赖起搏，且处于窦性心律。无一例有原发性三尖瓣功能障碍。在有和无主动RV起搏的两项连续超声心动图研究中评估TR分级和RV大小。结果显示，主动RV起搏与TR严重程度增加相关（TR瓣口缩窄宽度：0.4±0.2 vs. 0.2±0.2 cm，P<0.001；TR反流束面积：4.1±2.3 vs. 2.3±1.8 cm²，P<0.001）。这也反映在轻度TR患者数量显著减少（P = 0.003）和中度反流患者数量增加（P = 0.02）。起搏时RV面积无变化。
主动RV起搏与TR分级显著增加相关。这种效应不是由RV面积的急性变化引起的，且与电极干扰瓣叶关闭无关。
