Abstract
Background: Transvenous leads have been implicated in tricuspid
valve (TV) dysfunction, but limited data are available regarding the
effect of extracting leads across the TV on valve regurgitation.
Objective: The aim of this study is to quantify tricuspid
regurgitation (TR) before and after lead extraction and identify
predictors of worsening TR. Methods: We studied 321 patients
who had echocardiographic data before and after lead extraction. TR was
graded on a scale (0=none/trivial, 1=mild, 2=moderate, 3=severe). A
change of > 1 grade following extraction was considered
significant. Results: A total of 321 patients underwent
extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads
across the TV per patient). There was no significant difference in
average TR grade pre- and post-extraction (1.18 ± 0.91 vs. 1.15 ± 0.87;
p=0.79). TR severity increased after extraction in 84 patients, but was
classified as significantly worse (i.e. > 1 grade change in
severity) in only 8 patients (2.5%). Use of laser lead extraction was
associated with a higher rate of worsening TR post-extraction (44.0%
vs. 31.6%, p=0.04). Conclusion: In our single-center analysis,
extraction of leads across the TV did not significantly affect the
extent of TR in most patients. Laser lead extraction was associated with
a higher rate of worsening TR after extraction.