Abstract：
BACKGROUND: Endocardial leads of permanent pacemakers (PPM) and implantable defibrillators (ICD) across the tricuspid valve (TV) can lead to tricuspid regurgitation (TR) or can worsen existing TR with subsequent severe morbidity and mortality.
OBJECTIVE: To evaluate prospectively the efficacy of intraprocedural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR.
METHODS: We conducted a prospective randomized controlled study comparing echocardiographic results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55). Lead position was changed if TR grade was more than baseline in Group 1. Cohort patients underwent 2DTTE at baseline and 3 and/or 6 months after implantation. Excluded were patients with baseline TR > moderate or baseline ≥ moderate RV dysfunction.
RESULTS: The study comprised 111 patients (74.14 ± 11 years of age, 58.6% male, 19% ICD, 42% active leads). In 98 patients there was at least one follow-up echo. Two patients from Group 1 (3.6%) needed intraprocedural RV electrode repositioning. Four patients (3.5%, 2 from each group, all dual chamber PPM, 3 atrial fibrillation, 2 RV pacing > 40%, none with intraprocedural reposition) had TR deterioration during 6 months follow-up. One patient from Group 2 with baseline mild-moderate aortic regurgitation (AR) had worsening TR and AR within 3 months and underwent aortic valve replacement and TV repair.
CONCLUSIONS: The rate of mechanically induced lead-associated TR is low; thus, a routine intraprocedural 2DTTE does not have a significant role in reducing/preventing it.
OBJECTIVE: To evaluate prospectively the efficacy of intraprocedural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR.
METHODS: We conducted a prospective randomized controlled study comparing echocardiographic results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55). Lead position was changed if TR grade was more than baseline in Group 1. Cohort patients underwent 2DTTE at baseline and 3 and/or 6 months after implantation. Excluded were patients with baseline TR > moderate or baseline ≥ moderate RV dysfunction.
RESULTS: The study comprised 111 patients (74.14 ± 11 years of age, 58.6% male, 19% ICD, 42% active leads). In 98 patients there was at least one follow-up echo. Two patients from Group 1 (3.6%) needed intraprocedural RV electrode repositioning. Four patients (3.5%, 2 from each group, all dual chamber PPM, 3 atrial fibrillation, 2 RV pacing > 40%, none with intraprocedural reposition) had TR deterioration during 6 months follow-up. One patient from Group 2 with baseline mild-moderate aortic regurgitation (AR) had worsening TR and AR within 3 months and underwent aortic valve replacement and TV repair.
CONCLUSIONS: The rate of mechanically induced lead-associated TR is low; thus, a routine intraprocedural 2DTTE does not have a significant role in reducing/preventing it.
摘要：
背景：穿过三尖瓣（TV）的永久性起搏器（PPM）和植入式除颤器（ICD）的心内膜导线可导致三尖瓣返流（TR）或使现有的TR恶化，随后导致严重的发病率和死亡率。
目的：前瞻性评估术中二维经胸超声心动图（2DTTE）在降低/预防导线相关TR方面的功效。
方法：我们进行了一项前瞻性随机对照研究，比较了行术中回声引导右心室(RV)导线置入的患者（第1组，n=56）和非回声引导植入（第2组，n=55）的超声心动图结果。如果在第1组中TR等级大于基线,则改变导线位置。队列患者在基线和植入后3和/或6个月接受2DTTE。排除基线TR>中度或基线≥中度RV功能障碍的患者。
结果：该研究包括111名患者（74.14±11岁，58.6%男性,19%ICD,42%的活性引线)。98例患者至少有一次随访回声。第1组的两名患者（3.6％）需要术中重新定位RV电极。4名患者（3.5%，每组2个，所有双腔PPM，3房颤,2RV起搏>40%,在6个月的随访中，没有人进行术中复位）的TR恶化。第2组的一名患者基线轻度-中度主动脉瓣反流（AR）在3个月内TR和AR恶化，并接受了主动脉瓣置换术和电视修复。
结论：机械诱导的铅相关TR的发生率较低；因此，常规术中2DTTE在减少/预防方面没有显著作用.
目的：前瞻性评估术中二维经胸超声心动图（2DTTE）在降低/预防导线相关TR方面的功效。
方法：我们进行了一项前瞻性随机对照研究，比较了行术中回声引导右心室(RV)导线置入的患者（第1组，n=56）和非回声引导植入（第2组，n=55）的超声心动图结果。如果在第1组中TR等级大于基线,则改变导线位置。队列患者在基线和植入后3和/或6个月接受2DTTE。排除基线TR>中度或基线≥中度RV功能障碍的患者。
结果：该研究包括111名患者（74.14±11岁，58.6%男性,19%ICD,42%的活性引线)。98例患者至少有一次随访回声。第1组的两名患者（3.6％）需要术中重新定位RV电极。4名患者（3.5%，每组2个，所有双腔PPM，3房颤,2RV起搏>40%,在6个月的随访中，没有人进行术中复位）的TR恶化。第2组的一名患者基线轻度-中度主动脉瓣反流（AR）在3个月内TR和AR恶化，并接受了主动脉瓣置换术和电视修复。
结论：机械诱导的铅相关TR的发生率较低；因此，常规术中2DTTE在减少/预防方面没有显著作用.
