Hanafy Dicky A, Soesanto Amiliana M, Setianto Budhi, Immanuel Suzanna, Raharjo Sunu B, Amir Muzakkir, Yuniadi Yoga
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia.
Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta 10430, Indonesia.
J Clin Med. 2023 Jul 19;12(14):4782. doi: 10.3390/jcm12144782.
Permanent pacemaker implantation improves survival but can cause tricuspid valve dysfunction in the form of tricuspid regurgitation (TR). The dominant mechanism of pacemaker-mediated TR is lead impingement. This study evaluated the association between the location of the pacemaker leads crossing the tricuspid valve and the incidence of worsening TR and lead impingement using fluoroscopy. Lead positions were evaluated using perpendicular right anterior oblique (RAO) and parallel left anterior oblique (LAO) fluoroscopic angulation views of the tricuspid annulus. A two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate the maximum TR jet area-to-right atrium ratio and define regurgitation severity. A three-dimensional TTE was performed to evaluate lead impingement. A worsening of TR was observed in 23 of 82 subjects. Most leads had an inferior position in the RAO view and a septal position in the LAO view. The mid position in the RAO view and septal position in the LAO view were risk factors for lead impingement. Mid and septal positions were associated with higher risks of significant TR and lead impingement. Lead impingement was associated with a high risk of significant TR. Pacemaker-mediated TR remains a significant problem after lead implantation.
永久性起搏器植入可提高生存率，但可能导致三尖瓣反流（TR）形式的三尖瓣功能障碍。起搏器介导的TR的主要机制是导线撞击。本研究使用荧光透视法评估了穿过三尖瓣的起搏器导线位置与TR恶化及导线撞击发生率之间的关联。使用三尖瓣环的垂直右前斜位（RAO）和平行左前斜位（LAO）荧光透视角度视图评估导线位置。进行二维经胸超声心动图（TTE）以评估最大TR射流面积与右心房面积之比并确定反流严重程度。进行三维TTE以评估导线撞击。82名受试者中有23名观察到TR恶化。在RAO视图中，大多数导线位于下方位置，在LAO视图中位于间隔位置。RAO视图中的中间位置和LAO视图中的间隔位置是导线撞击的危险因素。中间和间隔位置与严重TR和导线撞击的较高风险相关。导线撞击与严重TR的高风险相关。起搏器介导的TR在导线植入后仍然是一个重要问题。
