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Incidence and predictors of tricuspid regurgitation (TR) after permanent pacemaker (PM) implantation were not well defined to date.
We sought to find out these predictors, especially focused on the influence of atrial fibrillation (AF).
A data of 578 patients underwent pacemaker implantation without significant TR (moderate or severe degree) in the baseline echocardiography were evaluated. The major outcomes were incidence of overall and isolated TR of moderate to severe degree in the follow-up echocardiography.
During a follow-up period of 7.3 years, overall TR were developed in the 95 patients (16.4%). The 48 patients (51%) had concomitant structural heart diseases (54.2% heart failure, 40.7% valvular disease), and 47 patients (49%) were presented as isolated TR. Multivariable analysis showed independent predictors of overall and isolated TR (table). Development of persistent/permanent AF (PeAF) was independent predictor of both overall and isolated TR. Patients with PeAF showed higher 7-year incidence of overall and isolated TR compared to PAF or those without AF (figure).
|Univariable analysis||Multivariable analysis|
|Variables||HR||95% CI||P-value||HR||95% CI||P-value|
|Overall TR progression|
|Pre-existing mild TR||2.17||1.18-3.98||0.013||2.31||1.24-4.27||0.008|
|RA-RV PG (1mmHg)||1.04||1.02-1.05||<0.001||1.02||1.00-1.03||0.121|
|Isolated TR progression|
|Pre-existing mild TR||3.12||1.12-8.73||0.030||3.02||1.07-8.55||0.037|
*Time-dependent covariates for extended Cox-proportional hazard model.
Patients with PeAF were at the higher risk of significant TR after PM implantation.