Table 2.

Mechanism of cardiac implantable electronic device-related tricuspid regurgitation by 3D echocardiography

Mode of TR	Echocardiographic findings	Example
Impingement	Normal diastolic excursion of the tricuspid valve leaflet with separation from the PPM lead Systolic apposition of the leaflet and lead with reduced systolic leaflet excursion.
Adhesions	PPM lead adhesion is diagnosed when the leaflet and lead move together throughout the cardiac cycle. Reduced systolic leaflet excursion.
Perforation	Defect in the body of the leaflet with PPM lead traversing the defect.
Subvalvular	Direct interference with chordae resulting in abnormal leaflet closure.

CIED, cardiac implantable electronic device; PPM, permanent pacemaker; TR, tricuspid regurgitation.