Delgado, V.

Fortuni, F.

Kley, F. van der

Marsan, N.A.

Leiden University Scholary Publications

Pacemaker lead-induced tricuspid regurgitation: consider leafletremodelingFortuni, F.; Kley, F. van der; Delgado, V.; Marsan, N.A.CitationFortuni, F., Kley, F. van der, Delgado, V., & Marsan, N. A. (2021). Pacemaker lead-inducedtricuspid regurgitation: consider leaflet remodeling. International Journal OfCardiovascular Imaging, 37(5), 1563-1565. doi:10.1007/s10554-020-02131-w Version: Publisher's VersionLicense: Creative Commons CC BY 4.0 licenseDownloaded from: https://hdl.handle.net/1887/3279656 Note: To cite this publication please use the final published version (if applicable).Vol.:(0123456789) The International Journal of Cardiovascular Imaging (2021) 37:1563–1565 https://doi.org/10.1007/s10554-020-02131-wIMAGES IN CV APPLICATIONSPacemaker lead‑induced tricuspid regurgitation: consider leaflet remodelingFederico Fortuni1 · Frank van der Kley1 · Victoria Delgado1 · Nina Ajmone Marsan1Received: 2 December 2020 / Accepted: 4 December 2020 / Published online: 27 January 2021 © The Author(s) 2021Cardiac implantable electronic device (CIED) can inter-fere with tricuspid valve (TV) function, induce significant tricuspid regurgitation (TR), and worsen patient prognosis [1]. We present a case of pacemaker (PM) lead induced severe TR (Fig. 1, Panel A-B) that led to progressive right atrial dilation and heart failure (HF) symptoms 2 years after PM implantation. Transthoracic 2- and 3-dimensional echocardiograms demonstrated a mechanical compression of the TV septal leaflet by the PM lead (arrow on Panel B and D of Fig.1 and Supplemental Video). The patient underwent lead extraction and a leadless PM was posi-tioned at the apex of the right ventricle (RV). Intracardiac echocardiography was performed during the procedure and showed persistence of severe TR after lead extraction (Fig. 1, Panel E) due to retraction (without rupture) of the septal leaflet (asterisk on Panel E of Fig. 1). Transthoracic echocardiography confirmed these findings and showed no significant RV remodeling (Fig. 1, Panel C). Due to persis-tence of HF symptoms, the patient underwent surgical TV replacement and the intra-operative inspection confirmed an isolated significant thickening and fibrosis of the TV septal leaflet (without rupture) probably induced by the mechani-cal compression of the PM lead. This case underlines the importance of aiming for a CIED lead position that does not interfere with the TV apparatus to avoid development of TR. Furthermore, we suggest careful imaging and clinical evaluation of patients who develop TR after CIED implanta-tion to optimize the timing for lead repositioning, since TR may not be reversible after lead extraction and surgical cor-rection is needed if irreversible damages of the TV leaflets have occurred.Supplementary information The online version of this article (https ://doi.org/10.1007/s1055 4-020-02131 -w) contains supplementary material, which is available to authorized users. * Nina Ajmone Marsan  N.Ajmone@lumc.nl1 Department of Cardiology, Heart LungCenter, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands1564 The International Journal of Cardiovascular Imaging (2021) 37:1563–15651 3Fig. 1  Pacemaker lead-induced tricuspid regurgitation. LA left atrium, LV left ventricle, RA right atrium, RV right ventri-cle, TV tricuspid valve1565The International Journal of Cardiovascular Imaging (2021) 37:1563–1565 1 3Funding This work did not receive any specific funding.Compliance with ethical standards Conflict of interest The Department of Cardiology of the Leiden University Medical Center received research grants from Abbott Vas-cular, Bayer, Bioventrix, Medtronic, Biotronik, Boston Scientific, GE Healthcare, Edwards Lifesciences and Medtronic. Nina Ajmone Marsan received speaking fees from Abbott Vascular and GE health-care. Victoria Delgado received speaker fees from Abbott Vascular, Medtronic, MSD, Edwards Lifesciences and GE Healthcare. The re-maining authors have nothing to disclose.Open Access This article is licensed under a Creative Commons Attri-bution 4.0 International License, which permits use, sharing, adapta-tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.Reference 1. Addetia K, Harb SC, Hahn RT, Kapadia S, Lang RM (2019) Car-diac implantable electronic device lead-induced tricuspid regur-gitation. JACC Cardiovasc Imaging 12:622–636Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Pacemaker lead-induced tricuspid regurgitation: consider leaflet remodeling

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Pacemaker lead-induced tricuspid regurgitation: consider leaflet remodeling

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