Abstract
Objective. To study the structural and functional state of the right heart in young patients with ventricular pacing in the long-term postoperative period.
Material and methods. We examined 58 patients (34 men and 24 women) with implanted pacemakers for atrioventricular block (AV block). Depending on the cause of AV block, patients were divided into two groups. Group 1 (РP+, CHD+) consisted of 28 people with a permanent pacemaker (PP) implanted after surgical correction of congenital heart disease (CHD) due to postoperative AV block; Group 2 (PP+, CHD-) – 30 people with non-surgical AV block that required implantation of a PP. All patients underwent general clinical examination and echocardiography. The age of the patients at the time of the study was 21.7 (19.2; 23.3) years in group 1 and 22.7 (20.1; 24.7) years in group 2; the duration of cardiac pacing was 15.9 (13.5; 18.2) years and 15.7 (13.9; 18.5) years, respectively. At the time of the study, all patients in both groups were implanted with dual-chamber pacemakers with 100% ventricular stimulation.
Results. When analyzing echocardiography data, it was found that in patients of group 1, compared with group 2, statistically significantly larger right atrium (RA) sizes were determined: volume index RA – 27.2 (23.6; 32.2) ml/m2 and 24.2 (21.6; 27.7) ml/m2, respectively (U=287.0, p = 0.039). In patients of group 1, compared with group 2, a significant decrease in the parameters of the longitudinal function of the right ventricle (RV) was found: the values of S' were 9.0 (8.3; 10.0) cm/s and 11.0 (11.0; 13.0) cm/s, respectively (p = 0.000); TAPSE – 15.0 (13.0; 16.0) mm at 19.0 (18.0; 21.0) mm, respectively (p = 0.000). The index of fractional area change (FAC) in the groups did not differ significantly and amounted to 51.2 (45.2; 56.2) % and 46.7 (43.4; 53.2) %, respectively (U = 313.5, p = 0.098). Signs of diastolic dysfunction were detected in 89% of patients in group 1 and in 53% of patients in group 2 (F = 0.156, p = 0.004). When considering the cause of valvular disorder of the right heart, it was found that in patients of group 1, severe regurgitation on the tricuspid valve (TV) was detected in 21% of cases, moderate regurgitation on the pulmonary valve (PV) – in 36% of cases, in patients of group 2, severe regurgitation on the TV was not recorded (F = 0.124, p = 0.009) and moderately severe insufficiency on the PV was detected in one patient (F = 0.170, p = 0.002). The progression of TV insufficiency to moderate and higher was noted in 78.5% of the studied in group 1 and in 94.0% of patients in group 2.
Conclusion. In patients with postoperative AV block, which occurred after surgical treatment of CHD in the long-term postoperative period, an expansion of the RA cavity and a decrease in the longitudinal function of the RV were noted, with normal values of FAC. In patients with non-surgical AV block, there were no significant violations of the geometry of the right heart and systolic function of the RV in the presence of moderate regurgitation on the TV.
References
- Glikson M., Nielsen J.C., Kronborg M.B., Michowitz Y., Auricchio A., Barbash I.M. et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur. Heart J. 2021; 42 (35): 3427–3520. DOI: 10.1093/eurheartj/ehab364
- Javed N., Iqbal R., Malik J., Rana G., Akhtar W., Zaidi S.M.J. Tricuspid insufficiency after cardiac-implantable electronic device placement. J. Commun. Hosp. Intern. Med. Perspect. 2021; 11 (6): 793–798. DOI: 10.1080/20009666. 2021.1967569
- Korkeila P., Mustonen P., Koistinen J., Nyman K., Ylitalo A., Karjalainen P. et al. Clinical and laboratory risk factors of thrombotic complications after pacemaker implantation: a prospective study. Europace. 2010; 12 (6): 817–824. DOI: 10.1093/europace/euq075
- Arabi P., Özer N., Ateş A.H., Yorgun H., Oto A., Aytemir K. Effects of pacemaker and implantable cardioverter defibrillator electrodes on tricuspid regurgitation and right sided heart functions. Cardiol. J. 2015; 22 (6): 637–644. DOI: 10.5603/CJ.a2015.0060
- Lee R.C., Friedman S.E., Kono A.T., Greenberg M.L., Palac R.T. Tricuspid regurgitation following implantation of endocardial leads: incidence and predictors. Pacing Clin. Electrophysiol. 2015; 38 (11): 1267–1274. DOI: 10.1111/pace.12701
- Addetia K., Harb S.C., Hahn R.T., Kapadia S., Lang R.M. Cardiac implantable electronic device lead-induced tricus-pid regurgitation. J.A.C.C. Cardiovasc. Imag. 2019; 12 (4): 622–636. DOI: 10.1016/j.jcmg.2018.09.028
- Nadar S.K., Mujtaba Shaikh M., Al Jabri S., Najeeb Rawahi M. The deleterious effect of intracardiac pacing leads on right ventricular function. Qatar Med. J. 2021; 2020 (3): 40. DOI: 10.5339/qmj.2020.40
- Saito M., Iannaccone A., Kaye G., Negishi K., Kosmala W., Marwick T.H. Effect of right ventricular pacing on right ventricular mechanics and tricuspid regurgitation in patients with high-grade atrioventricular block and sinus rhythm (from the protection of left ventricular function during right ventricular pacing study). Am. J. Cardiol. 2015; 116 (12): 1875–1882. DOI: 10.1016/j.amjcard.2015.09.04
- Wiechecka K., Wiechecki B., Kapłon-Cieślicka A., Tymińska A., Budnik M., Hołowaty D. et al. Echocardiographic assessment of tricuspid regurgitation and pericardial effusion after cardiac device implantation. Cardiol. J. 2020; 27 (6): 797–806. DOI: 10.5603/CJ.a2019.0053
- Webster G., Margossian R., Alexander M.E., Cecchin F., Triedman J.K., Walsh E.P. et al. Impact of transvenous ventricular pacing leads on tricuspid regurgitation in pediatric and congenital heart disease patients. J. Interv. Card. Electrophysiol. 2008; 21 (1): 65–68. DOI: 10.1007/s10840-007-9183-0
- Zhang X.X., Wei M., Xiang R., Lu Y.M., Zhang L., Li Y.D. et al. Incidence, risk factors, and prognosis of tricuspid regurgitation after cardiac implantable electronic device implantation: a systematic review and meta-analysis. J. Cardiothorac. Vasc. Anesth. 2022; 36 (6): 1741–1755. DOI: 10.1053/j.jvca.2021.06.025
- Tatum R., Maynes E.J., Wood C.T., Deb A.K., Austin M.A., O'Malley T.J. et al. Tricuspid regurgitation associated with implantable electrical device insertion: a systematic review and meta-analysis. Pacing Clin. Electrophysiol. 2021; 44 (8): 1297–1302. DOI: 10.1111/pace.14287
- Polewczyk A., Jacheć W., Nowosielecka D., Tomaszewski A., Brzozowski W., Szczęśniak-Stańczyk D. et al. Lead dependent tricuspid valve dysfunction – risk factors, improvement after transvenous lead extraction and long-term prognosis. J. Clin. Med. 2021; 11 (1): 89. DOI: 10.3390/jcm11010089
- Al-Bawardy R., Krishnaswamy A., Bhargava M., Dunn J., Wazni O., Tuzcu E.M. et al. Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin. Cardiol. 2013; 36 (5): 249–254. DOI: 10.1002/clc.22104
- De Cock C.C., Vinkers M., Van Campe L.C., Verhorst P.M., Visser C.A. Long-term outcome of patients with multiple (> or = 3) noninfected transvenousleads: aclinicalandechocardiographic study.Pacing Clin. Electrophysiol. 2000; 23 (4 Pt 1): 423–426. DOI: 10.1111/j.1540-8159.2000. tb00821.x
- Van De Heyning C.M., Elbarasi E., Masiero S., Brambatti M., Ghazal S., Al-Maashani S. et al. Prospective study of tricuspid regurgitation associated with permanent leads after cardiac rhythm device implantation. Can. J. Cardiol. 2019; 35 (4): 389–395. DOI: 10.1016/j. cjca.2018.11.014
- Fanari Z., Hammami S., Hammami M.B., Hammami S., Shuraih M. The effects of right ventricular apical pacing with transvenous pacemaker and implantable cardioverter defibrillator on mitral and tricuspid regurgitation. J. Electrocardiol. 2015; 48 (5): 791–797. DOI: 10.1016/j. jelectrocard. 2015.07.002
- Lee W.C., Fang H.Y., Chen H.C., Chen Y.L., Tsai T.H., Pan K.L. et al. Progressive tricuspid regurgitation and elevated pressure gradient after transvenous permanent pacemaker implantation. Clin. Cardiol. 2021; 44 (8): 1098–1105. DOI: 10.1002/clc.23656
- Rudski L.G., Lai W.W., Afilalo J., Hua L., Handschumacher M.D., Chandrasekaran K. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J. Am. Soc. Echocardiogr. 2010; 23 (7): 685–788. DOI: 10.1016/j.echo. 2010.05.010
- Lancellotti P., Pibarot P., Chambers J., La Canna G., Pepi M., Dulgheru R. et al. Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. Eur. Heart J. Cardiovasc. Imaging. 2022; 23 (5): e171– e232. DOI: 10.1093/ehjci/jeab253
- Zoghbi W.A., Adams D., Bonow R.O., Enriquez-Sarano M., Foster E., Grayburn P.A. et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J. Am. Soc. Echocardiogr. 2017; 30 (4): 303–371. DOI: 10.1016/j.echo.2017. 01.007
- Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
- Srivastava S., Bhatla P. Pulmonic valvular disease. In: Reich D.L., Fischer G.W. (Eds). Perioperative transesophageal echocardiography: a companion to Kaplan's cardiac anesthesia. Philadelphia: Elsevier Saunders; 2014: 163–166. DOI: 10.1016/b978-1-4557-0761-4.00017-7
- Puchalski M.D., Askovich B., Sower C.T., Williams R.V., Minich L.L., Tani L.Y. Pulmonary regurgitation: determining severity by echocardiography and magnetic resonance imaging. Congenit. Heart Dis. 2008; 3 (3): 168–175. DOI: 10.1111/j.1747-0803.2008.00184.x
- Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015; 28 (1): 1–39.e14. DOI: 10.1016/j.echo.2014.10.003
- Arrigo M., Huber L.C., Winnik S., Mikulicic F., Guidetti F., Frank M. et al. Right ventricular failure: pathophysiology, diagnosis and treatment. Card. Fail. Rev. 2019; 5 (3): 140–146. DOI: 10.15420/cfr.2019.15.2
- Papageorgiou N., Falconer D., Wyeth N., Lloyd G., Pellerin D., Speechly-Dick E. et al. Effect of tricuspid regurgitation and right ventricular dysfunction on long-term mortality in patients undergoing cardiac devices implantation: >10-year follow-up study. Int. J. Cardiol. 2020; 319: 52–56. DOI: 10.1016/j.ijcard.2020.05.062
- Valente A.M., Gauvreau K., Assenza G.E., Babu-Narayan S.V., Schreier J., Gatzoulis M.A. et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart. 2014; 100 (3): 247–253. DOI: 10.1136/heartjnl-2013-304958
- Grønlykke L., Korshin A., Holmgaard F., Kjøller S.M., Gustafsson F., Nilsson J.C. et al. Severe loss of right ventricular longitudinal contraction occurs after cardiopulmonary bypass in patients with preserved right ventricular output. Int. J. Cardiovasc. Imaging. 2019; 35 (9): 1661–1670. DOI: 10.1007/s10554-019-01616-7
- Maffessanti F., Gripari P., Tamborini G., Muratori M., Fusini L., Alamanni F. et al. Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, speckle-tracking, and three-dimensional echocardiographic study. J. Am. Soc. Echocardiogr. 2012; 25 (7): 701–708. DOI: 10.1016/j.echo.2012.03.017
- Tamborini G., Muratori M., Brusoni D., Celeste F., Mafessanti F., Caiani E.G. et al. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. Eur. J. Echocardiogr. 2009; 10 (5): 630–634. DOI: 10.1093/ejechocard/ ep015
- Senthilnathan S., Dragulescu A., Mertens L. Pulmonary regurgitation after tetralogy of Fallot repair: a diagnostic and therapeutic challenge. J. Cardiovasc. Echogr. 2013; 23 (1): 1–9. DOI: 10.4103/2211-4122.117975
- Cramer J.W., Ginde S., Hill G.D., Cohen S.B., Bartz P.J., Tweddell J.S. et al. Tricuspid repair at pulmonary valve replacement does not alter outcomes in tetralogy of Fallot. Ann. Thorac. Surg. 2015; 99 (3): 899–904. DOI: 10.1016/j.athoracsur.2014.09.086
About the authors
- Albert S. Garipov, Cardiologist, Postgraduate; ORCID
- Irina V. Pateyuk, Cand. Med. Sci., Associate Professor, Chief of Chair of General Medical Practice with a Course in Geriatrics and Palliative Medicine, Cardiologist; ORCID
- Konstantin V. Drozdovskiy, Cand. Med. Sci., Associate Professor, Cardiac Surgeon, Director; ORCID
