The Hidden Hazard of Pacemakers: Pacing Lead-Induced Tricuspid Regurgitation

A 65-year-old man with a history of complete heart block underwent pacemaker implantation. A few months later, he presented with symptoms of fatigue and shortness of breath. An echocardiogram was performed, which showed significant tricuspid regurgitation. The video below shows the echocardiogram images, which clearly demonstrate the pacing lead interfering with the tricuspid valve and causing regurgitation.

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As shown in the video, the pacing lead is seen to be interfering with the normal coaptation of the tricuspid valve leaflets, leading to significant regurgitation. This is a classic example of pacing lead-induced tricuspid regurgitation. The patient's symptoms were attributed to the regurgitation, and he underwent lead repositioning, which resolved the issue.

Pacing lead-induced tricuspid regurgitation is a complication that can arise in patients with permanent pacemakers. It occurs when the pacing lead, which is inserted through a vein and guided to the heart, interferes with the normal functioning of the tricuspid valve. This can lead to regurgitation, or the leakage of blood, through the valve.

The tricuspid valve is a critical structure in the heart that separates the right atrium and right ventricle. It is designed to allow blood to flow from the right atrium into the right ventricle while preventing blood from flowing backward. However, when a pacing lead is inserted, it can sometimes interfere with the valve's function, causing it to leak. This can lead to symptoms such as fatigue, shortness of breath, and swelling in the legs and feet.

Pacing lead-induced tricuspid regurgitation is a relatively rare complication, but it is an important one to recognize. It can be diagnosed using echocardiography, which provides valuable information about the valve's function and the lead's position. Treatment options include lead repositioning, lead extraction, or valve repair or replacement in severe cases.

In conclusion, pacing lead-induced tricuspid regurgitation is a potential complication of pacemaker implantation. It is essential to recognize the signs and symptoms of this condition and to use echocardiography to diagnose it. With prompt treatment, patients can experience significant improvement in their symptoms and quality of life.

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