Top

Published in:

15-12-2022 | Echocardiography | Original Article–cardiology

The differences between conventional lead, thin lead, and leadless pacemakers regarding effects on tricuspid regurgitation in the early phase

Authors: Yoshihiro Ohta, Akiko Goda, Aika Daimon, Eri Manabe, Kumiko Masai, Hideyuki Kishima, Takanao Mine, Masanori Asakura, Masaharu Ishihara

Published in: Journal of Medical Ultrasonics | Issue 1/2023

Abstract

Purpose

Trans-venous pacemaker leads are associated with worsening of tricuspid regurgitation (TR) after pacemaker implantation (PMI) in some cases. Recently, leadless pacemakers and thin ventricular pacemaker leads without a stylet lumen have become popular. However, the differences in the effects of these leads on TR are unclear. We investigated differences in the changes in TR in the early phase after PMI in patients with conventional leads, thin leads, and leadless pacemakers.

Methods

We enrolled 65 patients who underwent PMI (32 males, 79 ± 8 years), including 48 with trans-venous PMI (29 with conventional 6.0-Fr leads and 19 with 4.1-Fr thin leads) and 17 with leadless pacemakers. Transthoracic echocardiography was performed before and 1 month after PMI for assessment of conventional echocardiographic parameters and severity of TR by quantitative assessment.

Results

Atrial fibrillation was the most frequent indication for PMI in patients with leadless pacemakers (p = 0.015). In the before and 1 month after PMI comparison, left ventricular ejection fraction decreased after PMI only in the conventional lead group (p = 0.022). The TR effective regurgitant orifice area (EROA) decreased post PMI in the leadless (p = 0.002) and thin lead groups (p = 0.001), but not in the conventional lead group (p = 0.596). The change in TR EROA was greater in the leadless and thin lead groups as compared with the conventional lead group (p < 0.05).

Conclusion

The decrease in TR EROA in the early phase after PMI differed according to the type of pacemaker lead. The thin lead might be beneficial for reduction of TR after PMI.

Paniagua D, Aldrich HR, Lieberman EH, et al. Increased prevalence of significant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol. 1998;82:1130–2.CrossRefPubMed

Delling FN, Hassan ZK, Piatkowski G, et al. Tricuspid regurgitation and mortality in patients with transvenous permanent pacemaker leads. Am J Cardiol. 2016;117:988–92.CrossRefPubMedPubMedCentral

Salaun E, Tovmassian L, Simonnet B, et al. Right ventricular and tricuspid valve function in patients chronically implanted with leadless pacemakers. Europace. 2018;20:823–8.CrossRefPubMed

Schleifer JW, Pislaru SV, Lin G, et al. Effect of ventricular pacing lead position on tricuspid regurgitation: a randomized prospective trial. Heart Rhythm. 2018;15:1009–16.CrossRefPubMed

Nogami A, Kurita T, Abe H, et al. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. Circ J. 2021;85:1104–244.CrossRefPubMed

Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.CrossRefPubMed

Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30:303–71.CrossRefPubMed

Prinzen FW, Hunter WC, Wyman BT, et al. Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging. J Am Coll Cardiol. 1999;33:1735–42.CrossRefPubMedPubMedCentral

Prinzen FW, Peschar M. Relation between the pacing induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol. 2002;25:484–98.CrossRefPubMed

10.

Lieberman R, Padeletti L, Schreuder J, et al. Ventricular pacing lead location alters systemic hemodynamics and left ventricular function in patients with and without reduced ejection fraction. J Am Coll Cardiol. 2006;48:1634–41.CrossRefPubMed

11.

Sato-Iino T, Watanabe H, Koyama T, et al. The prevalence of apical wall motion abnormalities in patients with long-term right ventricular apical pacing. J Am Soc Echocardiogr. 2011;24:556–64.CrossRefPubMed

12.

Ahmed M, Gorcsan J 3rd, Marek J, et al. Right ventricular apical pacing-induced left ventricular dyssynchrony is associated with a subsequent decline in ejection fraction. Heart Rhythm. 2014;11:602–8.CrossRefPubMed

13.

de Cock CC, Giudici MC, Twisk JW. Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: a quantitative review. Europace. 2003;5:275–8.CrossRefPubMed

14.

Sweeney MO, Hellkamp AS. Heart failure during cardiac pacing. Circulation. 2006;113:2082–8.CrossRefPubMed

15.

Tops LF, Delgado V, Bax JJ. The role of speckle tracking strain imaging in cardiac pacing. Echocardiography. 2009;2:315–23.CrossRef

16.

Yoshikawa H, Suzuki M, Tezuka N, et al. Differences in left ventricular dyssynchrony between high septal pacing and apical pacing in patients with normal left ventricular systolic function. J Cardiol. 2010;56:44–50.CrossRefPubMed

17.

Gillis AM. Redefining physiologic pacing: lessons learned from recent clinical trials. Heart Rhythm. 2006;3:1367–72.CrossRefPubMed

18.

Beurskens NEG, Tjong FVY, de Bruin-Bon RHA, et al. Impact of leadless pacemaker therapy on cardiac and atrioventricular valve function through 12 months of follow-up. Circ Arrhythm Electrophysiol. 2019;12: e007124.CrossRefPubMed

19.

Yu YJ, Chen Y, Lau CP, et al. Nonapical right ventricular pacing is associated with less tricuspid valve interference and long-term progress of tricuspid regurgitation. J Am Soc Echocardiogr. 2020;33:1375–83.CrossRefPubMed

20.

Addetia K, Maffessanti F, Mediratta A, et al. Impact of implantable transvenous device lead location on severity of tricuspid regurgitation. J Am Soc Echocardiogr. 2014;27:1164–75.CrossRefPubMedPubMedCentral

Title: The differences between conventional lead, thin lead, and leadless pacemakers regarding effects on tricuspid regurgitation in the early phase
Authors: Yoshihiro Ohta
Akiko Goda
Aika Daimon
Eri Manabe
Kumiko Masai
Hideyuki Kishima
Takanao Mine
Masanori Asakura
Masaharu Ishihara
Publication date: 15-12-2022
Publisher: Springer Nature Singapore
Keywords: Echocardiography
Atrial Fibrillation
Echocardiography
Conventional Pacemaker
Conventional Pacemaker
Pacemaker
Pacemaker
Pacemaker
Published in: Journal of Medical Ultrasonics / Issue 1/2023
Print ISSN: 1346-4523
Electronic ISSN: 1613-2254
DOI: https://doi.org/10.1007/s10396-022-01274-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The differences between conventional lead, thin lead, and leadless pacemakers regarding effects on tricuspid regurgitation in the early phase

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Utility of ultrasonography for predicting indications for tolvaptan in patients with autosomal dominant polycystic kidney disease

Why is the depth/width ratio of a typical fibroadenoma small in breast ultrasonography?

Transabdominal ultrasonography is the bread and butter of diagnosis of abdominal disorders (in the past, present, and future)

Understanding the differences between Japanese and U.S. guidelines on clinical practice for contrast-enhanced ultrasound of the liver

A patient with breast fibroadenoma accompanied by carcinoma: early detection by screening

Reply to the comments on our article “Assessment of the risk of disease transmission during fine-needle aspiration cytology under ultrasound guidance by visualization of droplet and aerosol formation”