Outcomes of Tricuspid Regurgitation After Lead Extraction

Background: Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. Objective: The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. Methods: : We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0=none/trivial, 1=mild, 2=moderate, 3=severe). A change of > 1 grade following extraction was considered significant. Results: : A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference in average TR grade pre- and post-extraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p=0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e. > 1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR post-extraction (44.0% vs. 31.6%, p=0.04). 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.