SPC365

QRS Interval and Ventricular dyssynchrony – Role in Lead-Related Tricuspid regurgitation

Session: SESSÃO DE POSTERS 45 - DISPOSITIVOS CARDÍACOS IMPLANTÁVEIS: COMPLICAÇÕES E SUA PREVENÇÃO
Speaker: Catarina Sena Silva

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Catarina Sena Silva; Miguel Azeredo Raposo; Joana Rigueira; Ana Abrantes; Catarina Gregório; João Cravo; Marta Vilela; Pedro Alves Silva; Daniel Caldeira; Rui Plácido; Fausto J. Pinto; Catarina Sousa

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> </span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The pathophysiological mechanisms associated with the development of lead-related tricuspid regurgitation (TR) aren&rsquo;t limited to mechanical interference with the tricuspid valve and subvalvular apparatus. The adverse ventricular remodeling induced by electromechanical intraventricular dyssynchrony plays an important role. Our study aimed to assess if the QRS interval post cardiac implantable electronic device (CIED) was an independent predictor for the development of lead-related TR.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective cohort study of patients with a </span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>de novo</em></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> device implantation in the past 10 years. Baseline and post implantation electrocardiographic/echocardiographic parameters were obtained. Patients with TR worsening by at least 1 grade after CIED implantation were considered as lead-related TR (Group 1) and compared with a control group. We constructed a receiver operating characteristic (ROC) curve to identify the optimal QRS interval cutoff value to predict the development of lead-related TR. The area under the curve (AUC) was calculated to assess the diagnostic performance. Cardiovascular outcomes were assessed using 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:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Our study included</span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong> </strong></span></span></span><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">108 pts, 47% female with a mean age 73&plusmn;12 years. Single and dual-lead conventional pacemakers were the main implantable devices (45%). Regarding ECG data: Median baseline QRS was 123 vs 140ms in Group 1 and 2 respectively. Median QRS after CIED implantation was 158vs133ms Group 1 and 2 respectively.&nbsp;</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the group of patients who developed lead related TR at follow-up we observed a statistically significant increase of QRS interval in the first ECG post CIED implantation (28.861ms, p&lt;0.001).</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We found an optimal QRS cut-off value of 150ms with a sensitivity of 61% and specificity of 75% to predict the development of lead related TR. This value was an independent predictor with the development of severe TR after adjusting for multiple variables: age, TAPSE, ejection fraction, right atrium area, right ventricle dilation, atrial fibrillation, device (HR 3.935 CI 1.239-12.497, p=0.020). There was no statistically significant difference when analyzing the impact of QRS widening in cardiovascular outcomes.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In our study, we identified that the QRS interval with an optimal cut-off&gt;150ms post-CIED implantation and the subsequent intraventricular dyssynchrony, was an independent risk factor for the development of severe TR.</span></span></span></p>