Incidence and Severity of Tricuspid Regurgitation after Permanent Pacemaker: Single-Center Cohort in the Philippines

Abstract

Background: Tricuspid regurgitation related to permanent pacemaker (PPM) lead can occur in 25-29% of patients compared to individuals who did not undergo such procedure, with symptoms of right heart failure developing from six months to ten years after PPM implantation. Early detection is necessary as prompt intervention maybe required to prevent morbidity and even mortality. Aim: This study has been carried out to determine the incidence and severity of pacemaker lead-related tricuspid regurgitation (TR) immediately after the procedure and 1–3 months after permanent pacemaker implantation. Methods: This is a prospective cohort study on 60 patients who underwent permanent pacemaker implantation. Baseline demographic, electrocardiographic and echocardiographic parameters were collected. Patients underwent follow-up 2D- and 3Dechocardiogram within three days or prior to discharge and within one to three months after permanent pacemaker insertion to determine the development of tricuspid regurgitation (TR) or increase in its severity from baseline. Results: The mean age was 65.2 ± 13.5 years, majority were females (58%) who underwent permanent pacemaker implantation predominantly due to advanced atrioventricular block (75%). Three patients developed mild TR and one patient developed moderate TR within three days postoperatively. On follow-up within one to three months postoperatively, thirteen patients (22%) developed moderate TR and one patient developed severe TR, which required removal of the RV lead with improvement thereafter. Conclusion: In this study cohort, nearly one-fourth of patients who underwent implantation of permanent pacemaker developed at least moderate TR within one to three months of the procedure. Follow-up echocardiogram 3 months after pacemaker implantation may be warranted to detect this complication early.