3D Echocardiographic Location of Implantable Device Leads and Mechanism of Associated Tricuspid Regurgitation

JACC-CARDIOVASCULAR IMAGING

卷:7

Article

Mediratta, Anuj¹  Addetia, Karima¹  Yamat, Megan¹  Moss, Joshua D.¹  Nayak, Hemal M.¹  Burke, Martin C.¹  Weinert, Lynn¹  Maffessanti, Francesco¹  Jeevanandam, Valluvan¹  Mor-Avi, Victor¹  Lang, Roberto M.¹ 

[1] Univ Chicago, Dept Med, Cardiol Sect, Chicago, IL 60637 USA

关键词: intracardiac defibrillator;    pacemaker;    3-dimensional echocardiography;    tricuspid regurgitation;    tricuspid valve;   

DOI  :  10.1016/j.jcmg.2013.11.007

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to: 1) determine the feasibility of using 3-dimensional transthoracic echocardiography (3D TTE) in patients with implantable cardiac resynchronization devices, pacemakers, and defibrillators to visualize the device leads in the right heart and their position relative to the tricuspid valve leaflets; 2) determine the prevalence of different lead positions; and 3) study the relationship between lead location and tricuspid regurgitation (TR) severity. BACKGROUND Pacemaker, defibrillator, and cardiac resynchronization device implantation is currently guided by fluoroscopy, not allowing targeted lead positioning relative to the tricuspid valve leaflets. These leads have been reported to cause TR of variable degrees, but echocardiography is not routinely used to elucidate the mechanisms of lead interference with tricuspid valve leaflets in individual patients. METHODS 3D TTE full-volume images of the right ventricle and/or zoomed images of the tricuspid valve were obtained in 121 patients with implanted devices. Images were viewed offline to determine the position of the device-lead relative to the tricuspid valve leaflets. Severity of TR was estimated on the basis of vena contracta measurements. RESULTS 3D TIE clearly depicted lead position in 90% of patients. The right ventricular lead was impinging on either the posterior (20%) or septal (23%) leaflet or was not interfering with leaflet motion (53%) when positioned near the posteroseptal commissure or in the central portion of the tricuspid valve orifice. In the remaining patients, leads were impinging on the anterior leaflet (4%) or positioned in either the anteroposterior or anteroseptal commissure (3%). Leads interfering with normal leaflet mobility were associated with more TR than nonimpinging leads (vena contracta: median 0.62 cm [1st and 3rd quartiles: 0.51, 0.84 cm] vs. 0.27 cm [1st and 3rd quartiles: 0.00, 0.48 cm]; p < 0.001). CONCLUSIONS 3D TTE showed a clear association between device lead position and TR. To minimize TR induced by device-leads, 3D TTE guidance should be considered for placement in a comnnissural position. (C) 2014 by the American College of Cardiology Foundation

【 授权许可】

Free