Micra leadless pacemaker implantation was associated with clinically significant tricuspid regurgitation progression in 23.3% of patients over an average follow-up of 30 months (p<0.01).
Cohort (n=43)
Yes
Does leadless pacemaker implantation cause tricuspid regurgitation progression in patients without significant baseline TR?
Leadless pacemakers, often chosen to avoid tricuspid valve issues associated with transvenous leads, may still be associated with significant long-term tricuspid regurgitation progression.
p-value: p=<0.01
Abstract Background Leadless pacemakers (LPM) are often utilized over transvenous pacemakers to avoid tricuspid regurgitation (TR), yet the potential impact on long-term tricuspid valve (TV) dysfunction remains uncertain. This study investigates TR progression following LPM implantation, identifying potential risk factors and temporal trends. Methods Patients with Micra LPM implantation from 2015-2024 from two hospitals who had at least one follow-up echocardiogram within 5.5 years and postoperative CT scan were retrospectively enrolled and followed up to 5.5 years or until death, pacemaker inactivation, or a tricuspid or mitral valve intervention. Patients with previous pacemakers or moderate up to severe baseline TR were excluded. TR was graded within six categories (Fig-1). Clinically significant TR progression was defined as ≥2 grades worsening. A subgroup analysis was performed based on CT pacemaker location (apical, septal, or free wall) and echocardiogram follow up time (first 1.5 vs 1.5–5.5 years). Age, sex, heart failure (HF), device location, distance to apex, pacing percentage, and right ventricular (RV) size were retrospectively compared between the TR worsening vs no worsening group. Results Of 294 patients, we included 43 patients with mean age of 76.3 (+/- 10.2), 13 (30%) females, and followed them for an average of 30 (+/- 19.1) months. On CT scan, 62.8%, 13.9%, and 23.3% of LPMs were apical, septal, and on the free wall, respectively, with a mean distance-to-apex of 6.3 (+/- 9) mm. Ten patients (23.3%) had clinically significant TR worsening by the end of their respective follow-up (Fig-2). Regarding CT location, 26%, 33%, and 11% from the apical, septal, and free wall location subgroups developed significant worsening, respectively. On subgrouping by time, 14.3% had new onset worsening within the first 1.5 years compared to 22.2% within 1.5-5.5 years. A Paired Wilcoxon Signed-Rank test showed statistically significant TR progression from baseline in the overall cohort (p 0.01, Fig-1), as well as in the 1.5-year (p = 0.04) and the 1.5–5.5-year (p 0.01) subgroups. A sensitivity analysis for patients with outpatient-only follow-up echocardiograms showed similar results (29% developed TR worsening with statistically significant progression; p 0.01). Baseline characteristics were not significantly different between the TR worsening vs no-worsening groups. Conclusion TR significantly worsened following LPM implantation, with more prominent progression observed during the long-term follow up. Potential risk factors as pacing percentage, CT pacemaker location, and heart failure (HF) were comparable, which should be interpreted cautiously due to the small sample size. Controlling for possible confounding variables suggests a potential LPM-TV interaction. Further imaging analyses and prospective comparison to transvenous systems on larger sample sizes are needed.
Abdelsayed et al. (2025) conducted a cohort in Leadless pacemaker implantation (n=43). Micra leadless pacemaker was evaluated on Clinically significant tricuspid regurgitation progression (≥2 grades worsening) (p=<0.01). Micra leadless pacemaker implantation was associated with clinically significant tricuspid regurgitation progression in 23.3% of patients over an average follow-up of 30 months (p<0.01).
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