Long-term evaluation of factors potentially affecting tricuspid valve and right heart chamber function in patients with two endocardial right ventricular pacing leads

Aim. To assess factors influencing the degree of tricuspid regurgitation (TR) and the function of the right heart chambers in patients with two endocardial right ventricular leads of a permanent pacemaker.

Methods. A retrospective analysis of 5807 electronic medical records of patients who underwent primary implantation or planned replacement of a permanent pacemaker was performed. In 119 cases, a new right ventricular lead was additionally implanted, of which a group of 27 patients was selected according to the selection criteria. A control group of 129 patients was formed. Pseudo-randomization was performed, 27 comparable pairs were formed. To determine the predictors of TR progression, the logistic regression method for a multivariate model was used.

Results. In the late postoperative period, echocardiographic indices of both groups were virtually identical and were within the age norms. In the control group, minor TR was detected in 62.9% (n=17) of patients, moderate indices were diagnosed in 29.7% (n=8) of cases, and no TR was detected in 7,4% (n=2), respectively. In the observation group, minor TR was diagnosed in 74,1% of cases (n=20), moderate indices of insufficiency were diagnosed in 18.5% (n=5), severe TR was recorded in 3,7% (n=1) of patients, and TR was not detected in the same number of patients. Multivariate logistic regression identified the only independent predictor of TR progression in the postoperative period - the presence of non-paroxysmal atrial fibrillation (AF), which increases the probability of progression of the degree of tricuspid valve insufficiency in the remote observation period by 3/8 times. The relationship between the fact of the presence of two electrodes in the right ventricular cavity and the increase in the degree of tricuspid valve insufficiency was not determined.

Conclusion. In patients with two right ventricular leads, TR and right heart function don’t change significantly in the long-term observation period. The leading factor influencing TR progression is the history of non-paroxysmal AF.

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