Cardiac implantable electronic device‐induced tricuspid regurgitation: Implications and management

Abstract Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead‐induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing‐induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre‐existing TR have not been consistent predictors of CIED‐induced TR. While two‐dimensional echocardiography is helpful in assessing the severity of TR, three‐dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three‐dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED‐induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important.