. 2023 Dec 14;45(5):346–365. doi: 10.1093/eurheartj/ehad783

Table 1.

Prevalence and incidence of cardiac implantable electronic device-associated tricuspid regurgitation in several studies

Author of study	Year	Journal	No. of pts. with CIED	Country of origin	Study design	Cohort	Imaging modality	Prevalence and/or incidence of CIED-associated TR (%)
De Cock et al.⁹	2000	Pacing and Clinical Electrophysiology	96	Netherlands	Prospective	Study group (n = 48): 24 pts. − 2 ventricular leads + 1 atrial lead; 15 pts. − 2 atrial leads + 1 ventricular lead; 9 pts. − 2 two ventricular & 2 atrial leads. Controls-Equal number of pts matched for age, gender, indications for cardiac stimulation with DDD pacemakers, and duration of stimulation	Doppler echocardiography	Prevalence of TR: 20.8% (20/96 patients)
Leibowitz et al.¹⁰	2000	Cardiology	35	Israel	Prospective	35 consecutive patients referred to the electrophysiology service for the implantation of either permanent pacemakers or automatic implantable cardioverter defibrillators (ICDs)	2D and Doppler echocardiography	Incidence of worsened TR by one grade: 11.4% (4/35 patients)
Kucukarslan et al.¹¹	2006	Journal of Cardiac Surgery	61	Turkey	Prospective	Patients referred for the implantation of either permanent PM or ICD	M-mode, 2D, and Doppler echocardiography	Incidence of worsened TR by one grade: 13.1% (8/61 patients)
Webster et al.¹²	2008	Journal of Interventional Cardiac Electrophysiology	123	USA	Retrospective chart review	At least one transthoracic echocardiographic study before the placement of the transvenous lead and at least one echo afterwards	Echocardiography	TR increased by one grade in 22%, two grades in 3%
Kim et al.¹³	2008	Journal of the American Society of Echocardiography	248	USA	Retrospective chart review	Patients with pre- and post-implantation echocardiograms	Echocardiography	TR worsened by one grade or more: 24%, Severe TR developed in 3.9%
Klutstein et al.¹⁴	2009	Pacing and Clinical Electrophysiology	410	Israel	Retrospective chart review	Patients undergoing (permanent pacemaker implantation) PPI who had Doppler echocardiograms performed before and after PPI	Doppler echocardiography	TR worsened by ≥2 grades: 18.3% (75/410 patients)
Pfannmueller et al.¹⁵	2011	European Journal of Cardio-thoracic Surgery	116	Germany	Retrospective chart review	Patients with a previously implanted permanent ventricular pacemaker lead (PPL) and significant TR who underwent tricuspid valve (TV) surgery. Indications for isolated TV surgery were symptomatic severe tricuspid regurgitation (TR) while indications for TV surgery were symptomatic severe TR alone or at least mild-to-moderate TR with marked tricuspidal annular dilation in echocardiography (>4.0 cm) in patients with other indications for cardiac surgery.	Echocardiography	Prevalence of lead-related TR: 7% (8/116 patients).
Saito et al.⁶	2015	The American Journal of Cardiology	145	Australia	Prospective	Patients with persistent high grade atrioventricular block (defined as 2:1 atrioventricular block or higher) and sinus rhythm, scheduled to undergo dual-chamber pacemaker implantation	Transthoracic echocardiography	TR increased by one grade in 17.2%, two grades in 4.8%
Al-Bawardy et al.¹⁶	2015	Pacing and Clinical Electrophysiology	1596	USA	Prospective	Patients with first-time devices implantation which included ICD or PPM. One pre-implantation echocardiogram and at least one post-implantation echocardiogram.	Echocardiography	Prevalence of severe TR pre-implantation was 27%
Grupper et al.¹⁷	2015	The American Journal of Cardiology	689	Israel and USA	Retrospective analysis	Patients who underwent implantation of cardiac resynchronization therapy (CRT) or upgrade of other devices to CRT	Echocardiography	TR increased by at least one grade in 15%
Rothschild et al.¹⁸	2017	Journal of Interventional Cardiac Electrophysiology	36	USA	Prospective	Patients referred for PPM implantation	Limited 2D and colour Doppler transthoracic echocardiography (TTE)	TR increased by at least one grade in 17%
Anvardeen et al.¹⁹	2019	CJC Open	128	Canada, Australia, China	Prospective	Patients with pre-procedural echocardiograms within 48 h before lead implantation and follow-up echocardiograms at 4–6 weeks, 6 months, and 1 year after the procedure.	Echocardiograms (both 2D and 3D)	New or worsened TR: 29.7% (38/128), TR increased by only 1 grade: 25% (32/38)
Cho et al.²⁰	2019	Pacing and Clinical Electrophysiology	530	South Korea	Retrospective study	Patients admitted for PM implantation with baseline echocardiography and then 3 months post index procedure in OPD and yearly thereafter.	2D and Doppler echocardiography	Incidence of moderate to severe TR: 14.5%; of which isolated moderate to severe TR: 48.1%
Wiechecka et al.²¹	2020	Cardiology Journal	110	Poland	Observational, retrospective study,	Patients after first CIED implantation (PPM, ICD, or CRT), who had echocardiographic assessment of TR and PE before and after the procedure. Only patients with echocardiogram performed <60 days before and up to 7 days after implantation were included	2D transthoracic echocardiography	Acute new or worsened TR: 15.5%
Stassen J et al.²²	2022	Europace	852	Netherlands, Belgium, Finland,	Retrospective study	Patients with baseline and at least 6 months echocardiogram after CRT	Transthoracic echocardiography	TR worsened in 85 patients (9.9%)
Offen S et al.²³	2023	International Journal of Cardiology	9973	Australia	Retrospective study	Patients from a large multicentric echocardiographic registry (25 Australian centers)	Echocardiography	5490 (29.2%) mild TR; 3068(16.3%) moderate TR; and 1415 (7.5%) severe TR

CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PPI, permanent pacemaker implantation; PPM, permanent pacemaker; TR, tricuspid regurgitation; TTE, transthoracic echocardiography; TV, tricuspid valve.