| Part One.Influencing Factors of Tricuspid Regurgitation After Implantation of Right Ventricular Lead(Retrospective Study)Objective: By comparing the basic clinical date and echocardiography characteristics in patients with right ventricular lead before and after implantation,using two-dimensional transthoracic echocardiography(2D-TTE)and three-dimensional transthoracic echocardiography(3D-TTE),to study the influencing factors of lead-induce tricuspid regurgitation(LITR).Methods: 89 patients who underwent permanent pacemaker implantation in our hospital due to bradyarrhythmia and follow-up by 3D-TTE at least once time after operation during January 2014 to December 2019 were enrolled in our study.The types of permanent pacemakers include single right ventricular pacing(VVI)and dual chamber pacing(DDD).The patient who implant single lead atrial pacing(AAI),implantable cardioverter defibrillator(ICD),and cardiac resynchronization therapy(CRT)were excluded.Echocardiographic examinations were performed before and after the operation.The characteristics of echocardiographic were analyzed retrospectively.The patients were divided into two groups according to the changes of the degree of TR before and after operation,which include progressive group and non-progressive group,and the clinical data and echocardiographic characteristics were compared.Logistic regression analysis was carried out to explore the influencing factors of LITR.Results: 1.89 patients were enrolled in our study,which including 41 males(41.6%)and 48 females(53.9%)with an average age of(67.21±9.52)years and average body mass index(BMI)of(23.71 ± 2.54)kg/m2.The mean follow-up time was(510.70±133.92)days.2.25 of 89 patients showed significant progress of TR.The patients were divided into two groups according to the changes of the degree of TR before and after operation,which include progressive group and non-progressive group.Univariate analysis showed there was no significant differences in gender,BMI,basic diseases(including hypertension,diabetes,coronary heart disease,atrial fibrillation),pacing mode,preoperative New York Heart Association function class and the structure and function of cardiac between two groups(P>0.05).The progression group had more TR above grade one [(23/25)vs(34/64),P =0.001],more lead with fixation at the apex of the cardia [(21 / 25)vs(7 / 64),P< 0.001],more proportion of elderly patients [(72.84 ± 7.54)years vs(65.02 ± 9.36)years,P < 0.001],more interference with leaflet [(21 / 25)vs(54 / 64),P < 0.001] than in non-progressive group,and the days of the right ventricular lead implantation are longer than in non-progression group [(619.92 ± 124.34)vs(468.03 ± 112.16),P < 0.001].All the differences were statistically significant.3.The significant indexes in univariate analysis were included in the logistic regression analysis.The results showed that the days of implantation(OR 1.010,95% CI 1.001-1.020,P=0.036),the lead fixed at the apex(OR 39.538,95%CI 3.400~459.708,P=0.003),and the interference with leaflet(OR 36.858,95% CI 2.877-472.113,P=0.006)by lead were independent risk factors for the occurrence of significant progress TR after operation.Conclusion: The implantation of right ventricular lead can lead to the development of TR and 3DTTE is of great value for the follow-up after the operation.The significant TR after the implantation of right ventricular lead is related to the age,the days of implantation,the presence of more TR above grade one before operation,the path of the lead through and the fixed position of lead.Among them,the days of implantation,the lead disturb leaflet,and the lead fixed at the apex are independent risk factors for LITR.Part Two.Incidence and Influencing Factors of Tricuspid Regurgitation in Acute Stage After Implantation of Right Ventricular Lead(Prospective Study)Objective: By comparing the clinical date and echocardiography characteristics in patients with right ventricular lead before and three months after operation,using two-dimensional transthoracic echocardiography(2D-TTE)and three-dimensional transthoracic echocardiography(3D-TTE),to explore the incidence of lead induced tricuspid regurgitation(LITR)in acute stage and analyze the influencing factors.Methods: The subjects selected in our study were the patients who underwent permanent pacemaker(PPM)implantation for the first time in our hospital from August 2018 to April 2019 due to bradyarrhythmia and reexamined three months after the operation with 3D-TTE.The types of pacemakers include single chamber right ventricular pacing(VVI)and dual chamber pacing(DDD).The implantation of temporary pacemaker,single lead atrial pacing(AAI),implantable cardioverter defibrillator(ICD)and cardiac resynchronization therapy(CRT)were excluded.2D-TTE and 3D-TTE were performed before operation and three months after the operation.The clinical data and echocardiographic characteristics of 75 patients were analyzed to explore the incidence of LITR after the implantation of right ventricular lead and analyze the possible influencing factors after operation in acute stage.Results: 1.75 patients were enrolled in this study,which including 32 males(42.7%)and 43 females(57.3%)with an average age of(64.57 ± 11.59)years and an average body mass index(BMI)of(23.54 ± 2.66)kg / m2.2.7 of the 75 selected patients progressed to grade two or above within three months.The incidence of the occurrence of LITR after operation was 9.3%(7/75)within three months.There was no significant in age,gender,basic diseases(including hypertension,diabetes,coronary heart disease,atrial fibrillation),pacing mode,pacemaker dependence,the path of the lead through,the fixed position of lead,the preoperative New York Heart Association function class and the structure and function of cardiac between two groups(P>0.05).3.The right ventricle end-diastole volume(RVEDV)in progression group was increased three months after operation.Compared with the non-progression group,RVEDV was larger than that in the non-progression group and the differences were statistically significant between two group [(19.41 ± 3.53)vs(17.18 ± 2.48),P < 0.05].Conclusion: The incidence of the occurrence of LITR after operation was 9.3%(7/75)within three months after operation.In the short term,the progress of TR was not significantly related to gender,age,basic diseases,the path of the lead through and the fixed position of lead.The implantation of right ventricular lead will not affect the cardiac structure and function in a short period of time. |
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