Background:Lead-induced tricuspid regurgitation (TR) after cardiac implantable electronic device (CIED) implantation is not fully understood. This study aimed to reveal the features of lead-induced TR by 3-dimensional echocardiography (3DE) in patients with heart failure (HF) events after CIED implantation.

Methods and Results:In 143 patients, 3DE assessments for the tricuspid valve (TV) and right ventricular morphologies were sequentially performed within 3 days after CIED implantations, during TR exacerbations, and at ≥6 months after TR exacerbations. TR exacerbations were observed in 29 patients (median 10 months after CIED implantation, range 1–28 months), 15 of whom had lead-induced TR. In the 29 patients, the tenting height of the TV, tricuspid annular (TA) height, and TA area at baseline were independent predictors for worsening TR. In patients with lead-induced TR, tenting height of the TV and TA area were identified as the risk factors. In addition, all patients with a lead positioned on a leaflet immediately after CIED implantations developed lead-induced TR. At follow up, TR exacerbation of lead-induced TR persisted with TA remodeling, but it was improved in the lead non-related-TR group.

Conclusions:TA remodeling at baseline and a lead location on a leaflet immediately after CIED implantation were associated with lead-induced TR in patients with HF events after CIED implantation. Persistent TA remodeling may make lead-induced TR refractory against HF treatments.

背景：心脏植入式电子设备 (CIED) 植入后铅诱发的三尖瓣反流 (TR) 尚未完全了解。本研究旨在通过 3 维超声心动图 (3DE) 揭示 CIED 植入后心力衰竭 (HF) 事件患者中铅诱发的 TR 的特征。

方法和结果：在 143 名患者中，三尖瓣 (TV) 和右心室形态的 3DE 评估在 CIED 植入后 3 天内、TR 恶化期间和 TR 恶化后≥6 个月依次进行。在 29 名患者中观察到 TR 加重（CIED 植入后中位 10 个月，范围为 1-28 个月），其中 15 名患有铅诱导的 TR。在这 29 名患者中，TV 的帐篷高度、三尖瓣环 (TA) 高度和基线 TA 面积是 TR 恶化的独立预测因素。在铅诱发的 TR 患者中，TV 和 TA 区域的帐篷高度被确定为危险因素。此外，所有在 CIED 植入后立即将导线放置在传单上的患者都发生了导线诱发的 TR。在随访中，铅诱导的 TR 恶化持续存在 TA 重塑，

结论：在 CIED 植入后发生 HF 事件的患者中，基线 TA 重构和 CIED 植入后立即在传单上的导线位置与导线诱导的 TR 相关。持续的 TA 重塑可能会使铅诱导的 TR 对 HF 治疗无效。