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.