Progression of tricuspid regurgitation in patients with right ventricular pacing.

Objective: To compare the prevalence and progression of tricuspid regurgitation (TR) after the implantation of right-ventricular pacing cardiac implantable electronic devices (CIEDs) versus biventricular pacing devices.

Background: TR in patients with CIEDs is often linked to mechanical interference from leads, but studies show TR can also progress with leadless pacemakers, suggesting a direct effect of pacing.

Methods: We conducted a retrospective analysis of 549 patients who received a pacemaker (PM), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy (CRT) device. Follow-ups were conducted after one year and at least three years with aggregate interrogation and transthoracic echocardiography performed. Patients were categorized into two groups: right-ventricular (RV_all) pacing and biventricular (BiV) pacing.

Results: Median age was 68 [57-76] years, with 419 (76.3%) being male. Of these patients, 21.5% received an ICD, 30.4% a PM, and 48.1% a CRT device (RV_all: n = 285; BiV: n = 264). BiV patients had worse left ventricular (LV) function and more pronounced evidence of RV dilatation at baseline. After three years, a relevant TR was more prevalent in the RV paced patients (RV_all: 17.4%; BiV: 9.8%). Also, an increase in TR grade of ≥I° and ≥II° was more frequent in the RV_all group. While tricuspid annular systolic excursion (TAPSE) deteriorated in the RV_all group, it was preserved in the BiV group.

Conclusions: RV pacing was associated with a higher prevalence and severity of TR after CIED implantation compared to BiV pacing, but this effect might also be explained by significant differences in the group's clinical characteristics.