Effects of transvenous lead extraction on tricuspid regurgitation and right ventricular function assessed by echocardiography: a cohort study

Transvenous lead extraction in patients with cardiac implantable electronic devices (CIED) may be potentially associated with tricuspid valve damage and cardiac wall injury. Data on tricuspid valve damage after transvenous lead extraction are limited and discordant. Furthermore, the effects of transvenous lead extraction on right ventricular (RV) contractility have not been studied so far.

To investigate variations in tricuspid regurgitation (TR) degree and RV functional variables in a cohort of consecutive CIED patients undergoing transvenous pacemaker or defibrillator lead extraction at Karolinska University Hospital.

Twenty consecutive CIED patients (83±5 yr, 65% men) were assessed by two-dimensional transthoracic echocardiography and speckle tracking strain imaging before and after non-laser transvenous pacemaker or defibrillation lead extraction. TR degree, RV area and fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV global strain, and TR maximal velocity and gradient were evaluated. Four TR degrees were assessed: none (0), small (1), moderate (2), and severe (3).

After transvenous lead extraction no significant variation in TR degree was observed (1.4±0.9 vs. 1.6±0.9, p=0.16). RV systolic function was preserved both before and after transvenous lead extraction, as expressed by FAC (42.6±9.0 vs. 43.4±9.0%, p=0.58) and TAPSE (17.9±6.0 vs. 18.0±5.1 mm, p=0.98). Accordingly, RV GLS was similar before and after the procedure (-15.0±5.5 vs. -15.6±5.3%, p=0.38). No significant variations in TR maximal velocity (2.7±1.0 vs. 2.9±0.4 m/s, p=0.38) and gradient (32.9±15.1 vs. 33.9±9.8 mmHg, p=0.72) were observed following transvenous lead extraction.

Transvenous extraction of pacemaker or defibrillator leads was not associated with significant TR degree increase in a cohort of CIED patients assessed by echocardiography with speckle tracking strain imaging. RV function was unaffected by the procedure in terms of systolic contractility and global strain.