Prospective Study of Lead-associated Tricuspid Regurgitation in Patients Undergoing New Transvalvular Lead Insertion (LITR)

Hazem Omran

Status

Enrolling

Conditions

Left Bundle Branch Area Pacing

Pacemaker

Tricuspid Valve Regurgitation

ICD

Study type

Observational

Funder types

Other

Identifiers

NCT07342036

HDZ-KA_024_HO

Details and patient eligibility

About

The goal of this clinical trial is to record the incidence of newly developed or worsening tricuspid valve regurgitation (TR) following the implantation of a pacemaker or defibrillator with a transvenous lead. To collect this data, a transthoracic echocardiogram (TTE) with 3D imaging of the tricuspid valve (TV) will be performed before and after pacemaker implantation, with particular emphasis on assessing the tricuspid valve. Additionally, routine follow-up visits will be conducted at 6 and 12 months post-intervention, during which a TTE, ECG, NT-proBNP measurement, and pacemaker check will be performed.

Full description

The prevalence of tricuspid regurgitation (TR) in patients with a pacemaker or ICD/CRT device varies widely, ranging from 5% to 45% across different study protocols. To date, only retrospective analyses have shown that implantation of a device with a transvalvular lead can cause or worsen TR, highlighting the importance of early diagnosis. The aim of this study is to prospectively evaluate patients indicated for cardiac electronic device implantation to document the incidence of newly developed regurgitation (greater than trace) or worsening of existing regurgitation (by at least one grade). Additionally, the study will investigate predictive factors for the development or progression of TR.

Enrollment

200 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

medically indicated for pacemaker, ICD- or CRT implantation
No previous diagnosis of severe tricuspid regurgitation on enrollment
No existing transvalvular device (must be first implantation)
No other diagnosed severe valvular heart disease
Not previous diagnosis with pre-capillary pulmonary hypertension
No previous diagnosis of structural disease of the right ventricle (i.e. ACM, cardiac sarcoidosis, carcinoid...)

Exclusion criteria

Patients unable to give consent
Under the age of 18 years
Relevant pre-capillary pulmonary hypertension according to decision of the heart-team (sPAP echo >70 mmHg)
Severe tricuspid valve regurgitation (Grade 3 or worse) on enrollment
Patients who have undergone Lead-explantation
Exisiting valvular heart disease requiring treatment according to the decision of the heart-team. These patients may be enrolled in the study following treatment.
Previous tricuspid valve surgery
Patients with congenital heart disease (i.e. tetralogy of fallot, Ebstein's anomaly,...)
Pregnant or breastfeeding women
Life expectancy < 12 months