Research On The Relationship Between The Implantation Mode Of Electrode Leads In Cardiac Pacemakers And Tricuspid Regurgitation

Objective:The relationship between implantation mode of right ventricular pacing electrode leads and postoperative tricuspid regurgitation degree was studied retrospectively.The implantation mode of pacing electrode lead was mainly referred to the electrode lead tension and position when it was crossing tricuspid orifice and was evaluated by analyzing the chest X-ray examination in patients received cardiovascular implantable electronic devices(CIED).The related risk factors affecting postoperative tricuspid regurgitation was explored by multivariate Logistic regression.The possible clinical significance of intervention on these related risk factors to the prevention of postoperative tricuspid regurgitation(TR)was discussed.Methods:One hundred and ninety-eight patients with an enrolling of complete clinic and echocardiography data were consecutively selected in Department of Cardiology in Chinese PLA General Hospital between January 2014 to December 2016.All patients underwent a permanent pacemakers(PPM),implantable cardioverter defibrillator(ICD)or cardiac resynchronization therapy(CRT)implantation in Department of Cardiology in Chinese PLA General Hospital.According to the changes of tricuspid regurgitation degree observed by echocardiography before and after CIED implantation,patients were divided into unaggravated group(146 cases with unaggravated tricuspid regurgitation during follow-up)and aggregated group(52 cases with aggravated tricuspid regurgitation during follow-up).According to the position of the electrode leads of pacemaker shown on the chest X-ray,the implantation mode of cardiac pacemaker leads was divided into low tension group and high tension group.Patient's data of implantation mode of pacing leads,clinical and echocardiography parameters was collected and analyzed by multi-factor Logistic regression.Results:1.In the whole group of 198 cases,fifty-four(27.2%)patients had normal tricuspid valve function and one hundred forty-four(72.8%)patients had mild TR before CEID operation.No patient had more than mild TR before operation.During follow-up,TR was worsen in 54 patients(26.2%)and unchanged in 144 patients(73.8%).2.The degree of worsen TR during follow-up:one degree worsen in 40 patients(20.1%,37 cases from normal to mild degree,3 cases from mild to moderate degree),two degree worsen in 12 patients(6.1%,12 cases from mild to severe degree).There were no three degree worsen cases.3.Patients with high tension transtricuspid pacing lead in worsen TR group was significantly more than those in unchanged TR group(44.2%vs 15.8%,P=0.01).4.Multivariate Logistic regression analysis showed that the implantation mode of high pacing lead tension(P<0.05),lead implantation duration(P<0.05)and hyperlipidemia(P<0.05)may be independent risk factors for tricuspid regurgitation after transtricuspid lead implantation.Mild or less tricuspid regurgitation before CIED implantation would not aggravate tricuspid regurgitation after CIED implantation.Conclusion:The implantation mode of high lead tension,the implantation duration of transtricuspid pacing leads and hyperlipidemia might be the aggravated factors of tricuspid regurgitation during follow-up.Mild or less tricuspid regurgitation before CIED implantation will not aggravate tricuspid regurgitation after CIED implantation.During the implantation of CIED,it is suggested that the right ventricular electrode leads should be implanted in a way that reduces transtricuspid lead tension as much as possible and keep the leads in a relatively lower position to cross the tricuspid orifice,so as to reduce the incidence or worsen of tricuspid regurgitation after implantation and protect the patients from the damage of tricuspid function after operation.