Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Streszczenie

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation.
As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons.
Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR).
Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant).
Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Further
studies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.