What is LITR - Lead induced Tricuspid Regurgitation

When it comes to the tricuspid valve, echocardiography is the go-to tool for assessing its function and detecting any potential issues, including tricuspid regurgitation (TR). One often-overlooked cause of TR is lead-induced TR, which can occur in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The culprit here is usually the lead itself, which can interfere with the tricuspid valve's normal functioning, leading to regurgitation.

On echocardiography, the RV inflow view is particularly useful for assessing the tricuspid valve and detecting lead-induced TR. This view allows us to visualize the tricuspid valve leaflets and the lead's interaction with them. If the lead is impinging on the valve or interfering with leaflet coaptation, it can cause TR. We might see the lead entangled with the tricuspid valve leaflets, restricting their motion or preventing proper closure. Color Doppler can help us detect the presence and severity of TR, which can range from mild to severe.

The RV inflow view is especially useful for visualizing the lead's position and its relationship to the tricuspid valve. By adjusting the probe's position and angle, we can get a clear view of the lead's course across the tricuspid valve and assess its impact on valve function. If we notice significant TR, we might need to consider repositioning or revising the lead to minimize its impact on the valve.

Lead-induced TR can have significant clinical implications, particularly if it's severe or worsening over time. Patients might experience symptoms like fatigue, shortness of breath, or palpitations, which can impact their quality of life. As echocardiographers, it's essential to carefully assess the tricuspid valve and lead position in patients with pacemakers or ICDs, especially if they're showing signs of TR. By detecting lead-induced TR early, we can help guide management decisions and potentially prevent long-term complications.

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𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚 in Patient with AF and acute IS/TIA European Heart Association Guideline recommends: • 1 days after TIA • 3 days after mild stroke • 6 days after moderate stroke • 12 days after severe stroke Early anticoagulation can decrease a risk of recurrent stroke and embolic events but may increase a risk of secondary hemorrhagic transformation of brain infarcts. The 1-3-6-12-day rule is a known consensus with graded increase in delay of anticoagulation between 1 and 12 days after onset of ischemic stroke or transient ischemic attack(TIA), according to neurological severity based on European expert opinions. However, this rule might be somewhat later than currently used in a real-world practical setting.

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