The Effects Of His Bundle Pacing On Tricuspid Regurgitation

Objective:The aim of this study was to explore the effects of His bundle pacing on tricuspid regurgitation,and to analyze the possible causes and influencing factors.Methods:From March 2013 to October 2018,124 patients were receiving His bundle pacing in our center.15 patients were excluded who had no echocardiographic examinations for at least one month after His bundle pacing in our hospital,and a total of 109 patients were included in the retrospective analysis.Mild and lower valvular regurgitation is defined as normal regurgitation,and more than mild regurgitation is defined as abnormal regurgitation.We compared the changes of tricuspid regurgitation,mitral regurgitation and cardiac structure and function,such as left and right atrium size,left and right ventricular size,left ventricular ejection fraction,right ventricular systolic pressure,and so on after His bundle pacing.And further we looked for the possible reasons to explain the results.Results:Of the 109 patients,76(69.7%)were male,with an average age of 69.11±11.09 years.102 patients(93.6%)had a history of atrial fibrillation.The median follow-up time was 8(3,15)months,range from 1 to 60 months.Before His bundle pacing,there were normal tricuspid regurgitation group(57 cases)and abnormal regurgitation group(52 cases).There was no significant difference in tricuspid regurgitation after His bundle pacing(1.58 ±0.73 points vs 1.53±0.60 points,P=0.283).Further subgroup analysis showed that the tricuspid regurgitation increased after His bundle pacing in the normal tricuspid regurgitation group(1.17±0.45 points vs 0.96 ±0.19 points,P<0.005).There was no significant change of tricuspid regurgitation after operation in the abnormal tricuspid regurgitation group(2.04±0.71 points vs 2.14±0.48 points,P=0.155).After His bundle pacing,mitral regurgitation did not change significantly(1.49±0.80 points vs 1.55 ± 0.83 points,P=0.382),and left ventricular ejection fraction improved(56.63 ± 13.67%vs 53.81 ±15.05%,P=0.006);right ventricular systolic pressure decreased(40.63 ± 15.48 mmHg vs 45.02±17.15 mmHg,P<0.001);left ventricular end-systolic dimension and left ventricular end-diastolic dimension decreased compared with pre-operation(respectively,37.75±10.92 mm vs 39.95±11.82 mm,P<0.001;52.70+9.37 mm vs 54.74±10.15mm,P=0.001).Conclusions:His bundle pacing can improve cardiac function,reverse left ventricular remodeling,avoid the deterioration of mitral regurgitation,and not lead to the aggravation of tricuspid regurgitation in patients with more than mild tricuspid regurgitation before operation.However,for patients with no or mild tricuspid regurgitation before operation,tricuspid regurgitation may be aggravated after electrode implantation which acrossing the tricuspid annulus,we should pay special attention to avoid valve injury when implanted pacing lead across the tricuspid annulus,and pay close attention to the changes of valve regurgitation throughout the follow-up period.