O'Shea, Michael

Introduction: Tricuspid regurgitation (TR) is a common complication of right ventricle lead extraction (RVLE) in 5 to 10% of cases. This study aims to identify clinical outcomes such as predictors of heart failure hospitalization, need for tricuspid valve intervention, and death among patients with new severe TR after device lead removal (DLR). Methods: Patients who underwent DLR (pacemaker/ICD) between 3/1997 and 3/2024 were identified. Those who had an echocardiogram before and after RVLE with evidence of new severe TR were included. Cox univariable regression controlling for current age was used to assess association with death. Prentice Williams Peterson total time (PWPTT) Cox univariable regression was used to determine the rate of heart failure hospitalization up to three events per subject. Bivariable cox regression was used to control for ejection fraction for ICD and coil removal. Analysis was conducted using Stata IC16. Results: We identified 2,122 people who underwent RVLE, of whom 90 (4.24%) developed new severe TR and were included in the analysis. There were 68 hospitalizations among 38 people at a median of 2 years following lead extraction (IQR 0.57 to 4.5 years). The rate of hospitalization was 11.60 [9.14 to 14.71] per 100 person-years. Removal of an ICD was associated with increased hospitalization (HR 5.48 p<0.001) but not mortality (HR 1.21, p=0.707). Removal of a single coil ICD lead was associated with increased hospitalization rate (HR 3.01, p=0.031) but not mortality (HR =0.51, p=0.380). Removal of dual coil ICD lead was associated with more than a tenfold increase in hospitalization rate (HR 11.55, p=0.001) and four times the mortality rate (HR 4.05, p=0.031) (Figures 1&2). The presence of an abandoned (pacemaker/ICD) lead was associated with increased hospitalization (HR 5.75, p=0.004) and mortality (HR4.95, p=0.034). There was no change in hospitalization rate following tricuspid valve replacement (HR 1.33, p=0.716, n=18). Conclusion: Among people with new severe TR following DLR, the characteristics of the leads are strongly correlated with morbidity and mortality.