Mechanisms of Cardiac Implantable Electronic Device Interference With the Tricuspid Valve Apparatus

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-23 DOI:10.1016/j.amjcard.2025.04.016

Karima Addetia MD , Michael Henry MD , Heather Smith MD , Megan Yamat RDCS , Gene Kim MD , Renuka Jain MD , Eisha Wali MD , Linda Lee MD , Nathan Marzlin MD , AbdulRahman Abutaleb MD , Jonathan Crouch MD , Eric S. Weiss MD , Takeyoshi Ota MD , Christopher Salerno MD , Huihua Li MD , Aliya A. Husain MD , Valluvan Jeevanandam MD , Roberto M. Lang MD

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Abstract

Cardiac implantable electronic devices (CIEDs) have been implicated in the development of tricuspid valve (TV) dysfunction. However, the mechanisms of dysfunction are not well characterized. We sought to define the prevalence, location and mechanisms of CIED-TV interference based on direct inspection of gross pathologic specimens from consecutive patients with CIEDs who had undergone orthotopic heart transplantation (OHT). CIED-interference was classified by location (septal, posterior or anterior trigone of the RV), portion of TV apparatus involved (leaflet(s) only, sub-tricuspid apparatus (STA) only or a combination of both leaflet and STA) and type of interference (adherence, trapping or both). Sixty-two cases of CIED-TV interference were identified (5 leaflet, 30 STA and 27 leaflet and STA). The majority of patients had nonischemic cardiomyopathy (81%) and leads in situ for <10 years (77%). Most CIED-TV interference involved either the posterior (n = 23, 37%), septal (n = 15, 24%) or posteroseptal regions of the RV (n = 16, 26%). Interference with the anterior leaflet or anterior STA was rare. STA interference consisted of lead trapping behind the papillary muscles or chordae alone (n = 6), lead adherence with trapping (n = 21) and lead adherence alone (n = 3). Combination STA and leaflet interference consisted of adherence and trapping (n = 20) and adherence without trapping (n = 7). In conclusion, CIED-TV interference occurs most frequently with the STA in the posterior and septal regions of the RV. These findings have the potential to instruct imagers on how to evaluate for CIED-TV interference in an era where, elucidating the mechanism of TV dysfunction and considering options for repair is gaining momentum.

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心脏植入式电子装置干扰三尖瓣装置的机制。

心脏植入式电子装置（CIEDs）与三尖瓣（TV）功能障碍的发展有关。然而，功能障碍的机制尚不清楚。我们试图通过直接检查连续接受原位心脏移植（OHT）的cied患者的大体病理标本来确定CIED-TV干扰的患病率、位置和机制。cied干扰根据位置（RV的间隔区、后三角区或前三角区）、受累的TV器官部分（仅小叶、仅三尖瓣下器官或小叶和STA的组合）和干扰类型（粘附、困住或两者都有）进行分类。共发现62例干扰，其中单叶干扰5例，单叶干扰30例，单叶干扰27例。大多数患者有非缺血性心肌病（81%）和原位导联

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.