Rothschild Daniel P, Goldstein James A, Kerner Nathan, Abbas Amr E, Patel Meet, Wong Wai Shun
Department of Cardiovascular Medicine, Beaumont Health, 3601 West 13 Mile Road, Royal Oak, MI, 48073, USA.
Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, 48309, MI, USA.
J Interv Card Electrophysiol. 2017 Sep;49(3):281-287. doi: 10.1007/s10840-017-0266-2. Epub 2017 Jul 6.
Prior studies report permanent pacemaker (PPM)-induced tricuspid regurgitation (TR) in up to one third of cases late post-implantation. We sought to assess the extent of immediate PPM-induced TR.
Forty patients undergoing PPM implant were prospectively enrolled. Patients with pre-existing moderate or severe TR or an RVSP >50 mmHg were excluded. Pre- and immediate post-implantation transthoracic echocardiography (TTE) analyzed TR grade according to established methods. 3D TTE was utilized to determine lead position in relation to tricuspid leaflets as well as lead mobility across the TV.
Of 40 patients, four were excluded due to baseline moderate TR (n = 3) or RVSP >50 mmHg (n = 1). In the remaining cohort (n = 36), immediate post-implantation TTE showed no increase in TR grade in 30 patients (83%), whereas a one-grade increase from no/trace to mild occurred in six (17%) others. In no patient did immediate moderate or severe TR develop. Exclusive RV pacing was present in 47% of the patients; however, only two of the six patients with increased TR were paced. 3D TTE identified lead position in 92% of the cases-more than 50% of the cases showed RV lead distribution in the middle or post eroseptal commissure of the TV. Lead immobility was seen in only three of the six patients with increased TR.
These findings show that significant PPM-induced TR is uncommon immediately post-implantation and, when it occurs, causes no greater than mild TR. RV pacing and lead mobility do not correlate with worsening of TR. 3D TTE is highly reliable at identifying lead position.
既往研究报告，永久性起搏器（PPM）植入术后晚期，高达三分之一的病例会出现由其导致的三尖瓣反流（TR）。我们试图评估PPM植入后即刻导致TR的程度。
前瞻性纳入40例行PPM植入术的患者。排除既往存在中度或重度TR或右心室收缩压（RVSP）>50 mmHg的患者。植入前及植入后即刻行经胸超声心动图（TTE）检查，根据既定方法分析TR分级。采用三维TTE确定导线相对于三尖瓣小叶的位置以及导线在三尖瓣上的活动情况。
40例患者中，4例因基线中度TR（n = 3）或RVSP>50 mmHg（n = 1）被排除。在其余队列（n = 36）中，植入后即刻TTE显示，30例患者（83%）的TR分级未增加，而另外6例（17%）患者的TR分级从无/微量增加至轻度。无患者出现即刻中度或重度TR。47%的患者存在单纯右心室起搏；然而，TR增加的6例患者中只有2例接受了起搏。三维TTE在92%的病例中确定了导线位置，超过50%的病例显示右心室导线分布在三尖瓣的中间或后间隔连合处。在TR增加的6例患者中，仅3例观察到导线固定不动。
这些研究结果表明，PPM植入后即刻很少出现显著的由其导致的TR，即使出现，也不会导致超过轻度的TR。右心室起搏和导线活动与TR恶化无关。三维TTE在识别导线位置方面高度可靠。
