SPC365

Predictors and prognosis of lead related tricuspid regurgitation

Session: SESSÃO DE COMUNICAÇÕES ORAIS 05 – AVANÇOS NA GESTÃO DO RITMO CARDÍACO: UM OLHAR SOBRE AS INOVAÇÕES E OS RESULTADOS DO PACING
Speaker: Marta Vilela

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.5 Device Complications and Lead Extraction
Session Type: Comunicações Orais
FP Number: ---
Authors: Marta Miguez Vilela; Catarina Gregório; Joana Rigueira; João Cravo; Daniel Cazeiro; Pedro Alves Silva; Daniel Caldeira; Rui Plácido; João Agostinho; Fausto Pinto; Catarina Sousa

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction: </span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Tricuspid regurgitation (TR) is a known post procedure complication of cardiac implantable electronic device (CIED) implantation, with reported prevalences up to 45%. Limited data that predicts which patients will develop this complication exists.&nbsp;Lead related TR is an independent predictor of poor prognosis, associated with higher rates of heart failure (HF) hospitalizations and mortality. Our study aimed to identify predictors of increased risk of lead related TR and its impact on cardiovascular outcomes during follow-up.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: </span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Single center, retrospective study of patients with device implantation between 2010 and 2024 with a pre and post procedure transthoracic echocardiogram (TTE). The population was divided in 2 groups: Group 1 with lead related TR according to established criteria. The control group consistent of patients with mild TR before and after CIED implantation. Patients with at least moderate TR before CIED implantation were excluded. Time to first urgent care visit/admission for HF and death (all-cause and cardiovascular) were evaluated with the use of Kaplan&ndash;Meier estimates and Cox proportional-hazards models.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results: </span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">A total of 108 pts (68 in Group 1) were included, 63% male with a mean age of 73&plusmn;12 years. Median follow-up time was 5.9 years. The most common implantable devices were conventional single and dual-lead pacemakers (45%), followed by CRT-D (30%). Variables such as age (OR 1.109, atrial fibrillation (AF) (OR 23.033) and a QRS interval &ge; 150ms (OR 5.631) post CIED implantation were independent predictors for development of lead-related TR.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Regarding outcomes, in univariate analysis, patients with lead-related TR had an increased risk for cardiovascular death (23 pts (34%) in group 1 vs 2 pts (5%) in the control group </span><span style="font-family:Symbol">[</span><span style="font-family:&quot;Calibri&quot;,sans-serif">HR 4.794 CI 1.121-20-502</span><span style="font-family:Symbol">]</span><span style="font-family:&quot;Calibri&quot;,sans-serif">). There were no statistically significant differences regarding urgent care visit/hospitalization for HF in these 2 groups.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Finally, the presence of CIED related TR was independently associated with shorter CV survival, when adjusting for: age, gender, RV/LV function, AF and device type (HR 5.083, 95% </span><span style="font-family:Symbol">[</span><span style="font-family:&quot;Calibri&quot;,sans-serif">CI],1.091-23.678, p=0.038).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Our study showed that CIED-related TR was an independent risk factor for CV mortality. Key predictors include advanced age, AF, and a post-implant QRS interval &ge;150ms, suggesting the means for an early identification of patients at risk to further optimize care.</span></span></span></p>