Tricuspid regurgitation after cardiac device implantation: incidence and predictors in a prospective cohort

Introduction

Tricuspid regurgitation (TR), long regarded as a secondary and benign valve disorder, is now recognized as an important prognostic marker, particularly in patients with heart failure. Among acquired causes, cardiac implantable electronic devices (CIEDs) have emerged as a significant contributor to TR progression.

Objective

To assess the incidence and predictors of new or worsened TR following CIED implantation.

Methods

This prospective single-center study included all patients who underwent device implantation between June 2024 and March 2025. Transthoracic echocardiography was performed before implantation and repeated at 6 months to evaluate TR severity.

Results

Sixty patients were included (mean age 75 ± 10 years, sex ratio 0.49). Implanted devices consisted of 22 single-chamber pacemakers (36.7%), 36 dual-chamber pacemakers (60%), one CRT device (1.7%), and one ICD (1.7%).

Right ventricular lead position was apical in 70% and septal in 30%. No patient had more than moderate TR at baseline. No complications occurred during implantation or immediately thereafter.

At 6 months, 61.7% of patients demonstrated worsening TR. Significant predictors of TR progression included:

• presence of multiple leads (p = 0.01),

• apical right ventricular lead position (p = 0.03),

• impaired left ventricular diastolic function prior to implantation.

Conclusion

CIED implantation is associated with a substantial risk of TR aggravation. Multiple leads, apical lead positioning, and pre-existing diastolic dysfunction are key predictors of worsening TR. These findings underscore the importance of optimal lead placement and routine echocardiographic surveillance in patients receiving cardiac devices.