DEVELOPMENT OF SIGNIFICANT TRICUSPID REGURGITATION AFTER PACEMAKER IMPLANTATION: ASSOCIATION WITH RIGHT VENTRICULAR FUNCTION

Aim: Tricuspid regurgitation (TR) is a common complication after pacemaker implantation (PMI). However, its association with right ventricular (RV) function remains unclear. We aimed to clarify the association between RV function and TR development after PMI and its impact on clinical outcomes.

Sample and Methodology: A total of 455 patients underwent PMI with no/mild TR at baseline were included. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV FAC), and RV free wall strain (RV FWS). The primary endpoint was the development of moderate/severe TR during follow-up; the secondary endpoint was a composite of all-cause death or HF hospitalization.

Results: During a median follow-up of 4.0 (IQR: 1.8-7.2) years, significant TR developed in 166 (36%) patients. After adjusting for age, gender, atrial fibrillation, left sided valvular heart disease, pacing rate, left and right atrium dimension, and TR grade), RV FAC < 35% and RV FWS < 20% were independently associated with significant TR development (HR 1.46 [1.05-2.02], P = 0.02, and HR 1.87 [1.31-2.67], P < 0.001), while TAPSE

Conclusion: Decreased RV FAC and RV FWS are significantly associated with the development of TR after PMI. In these patients, the development of significant TR is associated with worse outcome at long-term follow-up, independently of RV dysfunction.