Effect of ventricular pacing lead position on tricuspid regurgitation: A randomized prospective trial

J. William Schleifer, Sorin V. Pislaru, Grace D Lin, Brian D. Powell, Raul Emilio Espinosa, Celeste Koestler, Trena Thome, Lynn Polk, Zhuo Li, Samuel J Asirvatham, Yong-Mei Cha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Pacing lead–related tricuspid regurgitation (TR), a recognized complication of ventricular pacing lead implantation, may be affected by lead position or diameter. Objective: This study sought to determine the effect of ventricular pacing lead position and diameter on pacing lead–related TR. Methods: A randomized prospective trial compared pacing leads in the right ventricular apex (RVA), right ventricular septum (RVS), or left ventricle via the coronary sinus (LV-CS) in a 1:1:1 fashion. Patients undergoing implantable cardioverter-defibrillator lead implantation in the RVA (RVA-ICD) were enrolled in a comparison group. Patients with preexisting moderate or greater TR were excluded. Prospective clinical evaluation, transthoracic echocardiograms, and device interrogation occurred 24 hours and 12 months after device implantation. Results: Sixty-three patients undergoing pacemaker implantation were randomized to RVA, RVS, or LV-CS pacing, and 48 RVA-ICD patients were enrolled as a comparison group. At 12 months, 6 patients (6.4%) developed moderate or greater TR. Moderate or greater TR was not significantly different between groups if analyzed by intention to treat (RVA 5.9%, RVS 10.0%, LV-CS 6.7%, and RVA-ICD 4.8%) or if analyzed by final lead location (RVA 4.8%, RVS 10.5%, LV-CS 8.3%, and RVA-ICD 5.1%). Ventricular lead–related complications occurred in 3 patients with right ventricular leads (3.2%) and 2 patients with LV-CS leads (11.1%) (P =.184). Conclusion: Neither pacing lead position nor diameter appears to affect TR development significantly. LV-CS leads failed to achieve a statistically significant reduction in TR as compared with right ventricular leads.

Original languageEnglish (US)
Pages (from-to)1009-1016
Number of pages8
JournalHeart Rhythm
Volume15
Issue number7
DOIs
StatePublished - Jul 1 2018

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Tricuspid Valve Insufficiency
Coronary Sinus
Heart Ventricles
Ventricular Septum
Equipment and Supplies
Implantable Defibrillators
Patient Rights
Lead

Keywords

  • Echocardiography
  • Implantable cardioverter-defibrillator
  • Left ventricular pacing
  • Pacing lead
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effect of ventricular pacing lead position on tricuspid regurgitation : A randomized prospective trial. / Schleifer, J. William; Pislaru, Sorin V.; Lin, Grace D; Powell, Brian D.; Espinosa, Raul Emilio; Koestler, Celeste; Thome, Trena; Polk, Lynn; Li, Zhuo; Asirvatham, Samuel J; Cha, Yong-Mei.

In: Heart Rhythm, Vol. 15, No. 7, 01.07.2018, p. 1009-1016.

Research output: Contribution to journalArticle

Schleifer, J. William ; Pislaru, Sorin V. ; Lin, Grace D ; Powell, Brian D. ; Espinosa, Raul Emilio ; Koestler, Celeste ; Thome, Trena ; Polk, Lynn ; Li, Zhuo ; Asirvatham, Samuel J ; Cha, Yong-Mei. / Effect of ventricular pacing lead position on tricuspid regurgitation : A randomized prospective trial. In: Heart Rhythm. 2018 ; Vol. 15, No. 7. pp. 1009-1016.
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abstract = "Background: Pacing lead–related tricuspid regurgitation (TR), a recognized complication of ventricular pacing lead implantation, may be affected by lead position or diameter. Objective: This study sought to determine the effect of ventricular pacing lead position and diameter on pacing lead–related TR. Methods: A randomized prospective trial compared pacing leads in the right ventricular apex (RVA), right ventricular septum (RVS), or left ventricle via the coronary sinus (LV-CS) in a 1:1:1 fashion. Patients undergoing implantable cardioverter-defibrillator lead implantation in the RVA (RVA-ICD) were enrolled in a comparison group. Patients with preexisting moderate or greater TR were excluded. Prospective clinical evaluation, transthoracic echocardiograms, and device interrogation occurred 24 hours and 12 months after device implantation. Results: Sixty-three patients undergoing pacemaker implantation were randomized to RVA, RVS, or LV-CS pacing, and 48 RVA-ICD patients were enrolled as a comparison group. At 12 months, 6 patients (6.4{\%}) developed moderate or greater TR. Moderate or greater TR was not significantly different between groups if analyzed by intention to treat (RVA 5.9{\%}, RVS 10.0{\%}, LV-CS 6.7{\%}, and RVA-ICD 4.8{\%}) or if analyzed by final lead location (RVA 4.8{\%}, RVS 10.5{\%}, LV-CS 8.3{\%}, and RVA-ICD 5.1{\%}). Ventricular lead–related complications occurred in 3 patients with right ventricular leads (3.2{\%}) and 2 patients with LV-CS leads (11.1{\%}) (P =.184). Conclusion: Neither pacing lead position nor diameter appears to affect TR development significantly. LV-CS leads failed to achieve a statistically significant reduction in TR as compared with right ventricular leads.",
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T1 - Effect of ventricular pacing lead position on tricuspid regurgitation

T2 - A randomized prospective trial

AU - Schleifer, J. William

AU - Pislaru, Sorin V.

AU - Lin, Grace D

AU - Powell, Brian D.

AU - Espinosa, Raul Emilio

AU - Koestler, Celeste

AU - Thome, Trena

AU - Polk, Lynn

AU - Li, Zhuo

AU - Asirvatham, Samuel J

AU - Cha, Yong-Mei

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Y1 - 2018/7/1

N2 - Background: Pacing lead–related tricuspid regurgitation (TR), a recognized complication of ventricular pacing lead implantation, may be affected by lead position or diameter. Objective: This study sought to determine the effect of ventricular pacing lead position and diameter on pacing lead–related TR. Methods: A randomized prospective trial compared pacing leads in the right ventricular apex (RVA), right ventricular septum (RVS), or left ventricle via the coronary sinus (LV-CS) in a 1:1:1 fashion. Patients undergoing implantable cardioverter-defibrillator lead implantation in the RVA (RVA-ICD) were enrolled in a comparison group. Patients with preexisting moderate or greater TR were excluded. Prospective clinical evaluation, transthoracic echocardiograms, and device interrogation occurred 24 hours and 12 months after device implantation. Results: Sixty-three patients undergoing pacemaker implantation were randomized to RVA, RVS, or LV-CS pacing, and 48 RVA-ICD patients were enrolled as a comparison group. At 12 months, 6 patients (6.4%) developed moderate or greater TR. Moderate or greater TR was not significantly different between groups if analyzed by intention to treat (RVA 5.9%, RVS 10.0%, LV-CS 6.7%, and RVA-ICD 4.8%) or if analyzed by final lead location (RVA 4.8%, RVS 10.5%, LV-CS 8.3%, and RVA-ICD 5.1%). Ventricular lead–related complications occurred in 3 patients with right ventricular leads (3.2%) and 2 patients with LV-CS leads (11.1%) (P =.184). Conclusion: Neither pacing lead position nor diameter appears to affect TR development significantly. LV-CS leads failed to achieve a statistically significant reduction in TR as compared with right ventricular leads.

AB - Background: Pacing lead–related tricuspid regurgitation (TR), a recognized complication of ventricular pacing lead implantation, may be affected by lead position or diameter. Objective: This study sought to determine the effect of ventricular pacing lead position and diameter on pacing lead–related TR. Methods: A randomized prospective trial compared pacing leads in the right ventricular apex (RVA), right ventricular septum (RVS), or left ventricle via the coronary sinus (LV-CS) in a 1:1:1 fashion. Patients undergoing implantable cardioverter-defibrillator lead implantation in the RVA (RVA-ICD) were enrolled in a comparison group. Patients with preexisting moderate or greater TR were excluded. Prospective clinical evaluation, transthoracic echocardiograms, and device interrogation occurred 24 hours and 12 months after device implantation. Results: Sixty-three patients undergoing pacemaker implantation were randomized to RVA, RVS, or LV-CS pacing, and 48 RVA-ICD patients were enrolled as a comparison group. At 12 months, 6 patients (6.4%) developed moderate or greater TR. Moderate or greater TR was not significantly different between groups if analyzed by intention to treat (RVA 5.9%, RVS 10.0%, LV-CS 6.7%, and RVA-ICD 4.8%) or if analyzed by final lead location (RVA 4.8%, RVS 10.5%, LV-CS 8.3%, and RVA-ICD 5.1%). Ventricular lead–related complications occurred in 3 patients with right ventricular leads (3.2%) and 2 patients with LV-CS leads (11.1%) (P =.184). Conclusion: Neither pacing lead position nor diameter appears to affect TR development significantly. LV-CS leads failed to achieve a statistically significant reduction in TR as compared with right ventricular leads.

KW - Echocardiography

KW - Implantable cardioverter-defibrillator

KW - Left ventricular pacing

KW - Pacing lead

KW - Tricuspid regurgitation

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