Conclusion:
In our single-center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction.
Keywords : lead extraction, tricuspid regurgitation, extraction tools
Introduction :
Transvenous lead extraction (TLE) remains a critical part of lead management in patients with cardiac implantable electronic devices (CIED).1,2 TLE is an effective procedure for removal of cardiac implantable leads with a high rate of success and a low risk of major complications.3 While transvenous leads have been implicated as a cause of tricuspid regurgitation (TR), the incidence of TR attributable to leads and the impact of lead extraction on the extent of TR are poorly defined. Although lead removal has been proposed as a way to treat TR, TLE often will not improve the degree of regurgitation and in some cases, may worsen TR by injuring the tricuspid valve (TV) or sub-valvular apparatus.4 Additionally, the association between TR and worse outcomes in patients with heart failure has resulted in a proliferation of percutaneous therapies to address regurgitation.5 For patients who are being considered for percutaneous tricuspid interventions who have existing leads across the TV, the role, timing and impact of TLE on TR prior to percutaneous intervention is also an area of uncertainty.
In light of the uncertainties regarding the impact of TLE on TR, we sought to quantify TR before and after TLE.