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Right-heart valve deterioration traced to pacing type, revealing distinct tricuspid vulnerability with right-ventricular lead placement.  

Researchers conducted a retrospective study published in June 2025 issue of Clinical Research in Cardiology to compare the prevalence and progression of tricuspid regurgitation (TR) following implantation of right-ventricular (RV_all ) pacing cardiac implantable electronic devices (CIEDs) implantation vs biventricular (BiV) pacing devices.  

They analyzed data from 549 individuals who received a pacemaker (PM), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy (CRT) device. Follow-up evaluations were conducted in 1 year and after at least 3 years, using device interrogation and transthoracic echocardiography. Individuals were grouped into RV_all pacing and BiV pacing categories.  

The results showed that the median age was 68 years [57–76], and 419 individuals (76.3%) were male. Among the cohort, 21.5% received an ICD, 30.4% a PM, and 48.1% a CRT device (RV_all: n = 285; BiV: n = 264). Individuals in the BiV group had poorer baseline left ventricular (LV) function and greater RV dilatation. At 3 years, relevant TR occurred more often in the RV_all  group (17.4%) than in the BiV group (9.8%). The TR grade increases of ≥I^°  and ≥II^°  were also more frequent in the R_all  group. Tricuspid annular plane systolic excursion (TAPSE) declined in the RV_all  group but remained stable in the BiV group.  

Investigators concluded that RV_all pacing was linked to greater prevalence and severity of TR following CIEDs implantation, although this association may have been influenced by baseline clinical differences between groups.

Source: link.springer.com/article/10.1007/s00392-025-02684-7