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 language | English (US) |
|---|---|
| Pages (from-to) | 1009-1016 |
| Number of pages | 8 |
| Journal | Heart Rhythm |
| Volume | 15 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2018 |
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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 journal › Article
}
TY - JOUR
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
PY - 2018/7/1
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
UR - http://www.scopus.com/inward/record.url?scp=85048756563&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048756563&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2018.02.026
DO - 10.1016/j.hrthm.2018.02.026
M3 - Article
C2 - 29496605
AN - SCOPUS:85048756563
VL - 15
SP - 1009
EP - 1016
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 7
ER -