PACEMAKER FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT ASSOCIATED WITH INCREASED TRICUSPID REGURGITATION
Nona P, Parikh S, Zweig B, Eng M, Lee J, Frisoli T, Aka T, Isley MM, O'Neill W, and Dee Wang D. PACEMAKER FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT ASSOCIATED WITH INCREASED TRICUSPID REGURGITATION. J Am Coll Cardiol 2019; 73(9):1997.
J Am Coll Cardiol
Background: Transcatheter Aortic Valve Replacement (TAVR) therapies have increased in the treatment of aortic disease. As TAVR procedures increase, more data is available on complications, such as the development of conduction abnormalities, often requiring pacemaker placement (PMP). A common complication of pacemaker lead placement is the development of tricuspid regurgitation (TR) due to wire impingement of leaflet function and coaptation. Methods: From January 2014 through June 2018, all patients who underwent TAVR at a single center were retrospectively analyzed. Of 796 patients, 89 patients (11%) underwent PMP following TAVR procedure. Of these 89 patients, 34 patients had 2-year follow-up data post-pacemaker implantation. Baseline patient characteristics, echocardiographic variables and major adverse clinical events were analyzed. Echographic data was obtained  prior to TAVR  between TAVR and PMP and  the most recent echocardiogram. Data obtained from the echocardiogram included ejection fraction, degree of TR, pulmonary artery pressure, tricuspid annular plane systolic excursion, degree of inferior vena cava dilation, right ventricular diameter (RVD), right ventricle systolic pressure and right atrium (RA) area. Results: Overall, there was a trend towards increased tricuspid regurgitation severity from 29% to 38% following TAVR and PMP. The various changes between echographic parameters were analyzed using paired t-test and Wilcoxon signed rank test. The results additionally indicate a statistically significant change for the RVD, where the mean RVD increased from 2.9 cm to 3.5 cm (p-value = 0.039). While not statistically significant, it should also be noted that there was an increase in RA size by area evaluation. Conclusion: This is the first study to quantify this sequela of pacemaker implantation following TAVR. Our results demonstrate an increased incidence of worsening tricuspid regurgitation severity post-TAVR pacemaker implantation. Given recent advances in transcatheter tricuspid valve therapies, more research is required on this complication of TAVR procedure to better optimize patient selection for transcatheter aortic valve replacement.