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Laser sheath, female sex associated with higher incidence of traumatic tricuspid regurgitation
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Certain tools beyond simple traction used in percutaneous ventricular lead extraction may be associated with a higher incidence of traumatic tricuspid regurgitation.
Researchers at the University Hospital La Timone in Marseilles, France, included 208 consecutive patients in the single-center study. A total of 237 ventricular leads were removed using either the simple traction, laser sheath and/or lasso techniques. The presence of traumatic tricuspid regurgitation was assessed using transthoracic ECG.
According to the results, 19 (9.1%) patients had a traumatic tricuspid regurgitation. Following a univariate analysis, researchers reported five factors associated with the occurrence of traumatic tricuspid regurgitation. The use of a laser sheath beyond simple traction (OR=10.17; 95% CI, 2.16-94.74), the use of any additional tool beyond simple traction (OR=8.96; 95% CI, 2.02-81.45), the extraction of two or more leads per patient (OR=4.67; 95% CI, 1.38-14.48), female sex (OR=3.36; 95% CI, 1.14-9.90) and a longer mean time from lead implantation (OR=1.01; 95% CI, 1.00-1.01) were all associated with increased occurrence of traumatic tricuspid regurgitation. A multivariate analysis revealed that the use of a laser sheath beyond simple traction (P=.004), the use of both laser sheath and lasso (P=.02) and female sex (P=.02) were independent predictors of traumatic tricuspid regurgitation. There was also a nonsignificant trend toward increased mortality in the traumatic tricuspid regurgitation population.
Franceschi F. J Am Coll Cardiol. 2009;53:2168-2174.
This is an important study in that it emphasizes a number of points about pacemaker lead removal. First, it is not a benign procedure and about one in 10 patients in this series had enough tricuspid valve damage to cause traumatic tricuspid regurgitation. Second, it emphasizes the necessity for evaluation of tricuspid regurgitation after lead removal – and the importance of recognizing traumatic tricuspid regurgitation as a complication. Third, the occurrence of traumatic tricuspid regurgitation is “unpredictable” in that it results commonly from the use of extraction tools rather than simple traction … One might assume that if recognition of traumatic tricuspid regurgitation is done early it will allow for earlier and more successful treatment of right-sided HF, but this study does not tell us the usefulness of that strategy.
– Peter C. Block, MD
Cardiology Today Co-Section Editor