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The distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: effects on postoperative tricuspid regurgitation deterioration

  • Qingyun Hu
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Hongzhao You
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    State Key Laboratory of Cardiovascular Disease, Endocrine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Keping Chen
    Correspondence
    Corresponding author: Dr. Keping Chen, State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Yan Dai
    Correspondence
    Dr Yan Dai, State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, No. 167 N Lishi Rd, Xicheng District, Beijing 100037, China.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Wenzhao Lu
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Yao Li
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Chendi Cheng
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Yu’an Zhou
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Jiaqi Wang
    Affiliations
    Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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  • Ruohan Chen
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Shu Zhang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Published:November 05, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.027

      Abstract

      Background

      Left bundle branch pacing (LBBP) is an alternative strategy for His bundle pacing (HBP), however little is known about tricuspid regurgitation (TR) deterioration after LBBP implantation.

      Objectives

      This study aimed to characterize the incidence of post-LBBP TR deterioration and identify predicting factors, especially lead position parameters.

      Methods

      Patients who received LBBP were continuously enrolled from January 2018 to August 2020. The progression of TR and the anatomic position of LBBP characterized by echocardiography.

      Results

      A total of 89 patients were enrolled and assigned to two sub-groups based on the degree of TR before LBBP implantation. 58 (65.2%) patients with relatively normal TV function (Grade0/1 subgroup: with none/trivial or mild TR) and 31 (34.8%) with more severe TR (Grade2/3 subgroup: with moderate or severe TR). With 19.0±6.5 months of follow-up time, 29 (32.6%) patients had TR deterioration and 23 of them were in Grade 0/1 subgroup. In Grade 0/1 subgroup, patients with TR deterioration had a shorter distance between the lead-implanted site and tricuspid valve (Lead-TA-dist) than those without TR (19.0±7.6 vs 23.9±5.4, P=0.006). The receiver operating characteristic (ROC) curve (AUC=0.721, 95%CI 0.575 to 0.867, P=0.005) indicated the favorable efficacy of Lead-TA-dist for predicting TR deterioration after LBBP. The lead-TA-dist ≤ 16.1mm was independently associated with TR deterioration after LBBP (HR 0.20, 95% CI 0.06 – 0.76, P = 0.017).

      Conclusion

      TR was a common complication of LBBP implantation. In patients with none/trivial or mild TR, lead-TA-dist ≤ 16.1mm was an independent predictor of TR deterioration after LBBP implantation.

      Keywords

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