Percutaneous pacemaker or implantable cardioverter-defibrillator lead removal in an attempt to improve symptomatic tricuspid regurgitation

Mohammed N. Nazmul, Yong-Mei Cha, Grace D Lin, Samuel J Asirvatham, Brian D. Powell

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

AimsPacemaker and implantable cardioverter-defibrillator (ICD) leads can cause tricuspid valve regurgitation (TR). Few data are available on the best management of significant TR that develops after pacemaker or ICD implantation and regarding any benefits of right ventricular (RV) lead extraction. We sought to determine the impact of RV lead removal on lead-induced TR.Methods and resultsWe reviewed all patients between 1 January 2000 and 31 December 2010 at the tertiary care hospital who had a preoperative indication of TR and underwent percutaneous extraction of an RV lead with the intent of trying to correct moderate or severe TR. Pre- and post-procedure echoes and clinical data were retrospectively reviewed. In the four patients identified, the RV lead was removed and placed in the coronary sinus to try to improve moderate or severe TR due to lead impingement. There was no significant improvement in the degree of TR except one patient where TR improved slightly from moderate to mild-moderate. All patients had a dilated tricuspid valve annulus by the time of lead extraction. Tricuspid annulus dilatation appeared to account for the persistent TR after RV lead removal.ConclusionA greater degree of tricuspid valve annulus dilatation may be a marker and mechanism for irreversible lead-induced TR. Further studies are needed to determine whether surgical tricuspid valve repair or replacement combined with RV lead extraction would result in better outcomes than a percutaneous lead extraction approach.

Original languageEnglish (US)
Pages (from-to)409-413
Number of pages5
JournalEuropace
Volume15
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Tricuspid Valve Insufficiency
Implantable Defibrillators
Tricuspid Valve
Dilatation
Coronary Sinus
Patient Rights
Tertiary Healthcare
Lead
Surgical Instruments
Tertiary Care Centers

Keywords

  • Coronary sinus
  • Implantable cardioverter-defibrillator
  • Pacemaker
  • Tricuspid regurgitation
  • Tricuspid valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Percutaneous pacemaker or implantable cardioverter-defibrillator lead removal in an attempt to improve symptomatic tricuspid regurgitation. / Nazmul, Mohammed N.; Cha, Yong-Mei; Lin, Grace D; Asirvatham, Samuel J; Powell, Brian D.

In: Europace, Vol. 15, No. 3, 03.2013, p. 409-413.

Research output: Contribution to journalArticle

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