tricuspid valve dysfunction

I strongly suggeset everyone on this forum with a 2 lead pacemaker at least scan an online article on tricuspid valve dysfunction. http://www.onlinejacc.org/content/accj/69/18/2331.full.pdf. You will be surprised to learn about the number and seriousness of issues around the interference of PM leads with the triscuspid valve assembly. Based on my experience, some of the issues raised in earlier posts are likely derived from valve problems caused by PM leads.


6 Comments

TR

by Lonestar - 2018-12-08 19:28:26

The first order symptom of a damaged TV is regurgitation, which any doctor should pick up with a stethoscope. An echo would show damage in detail. As the article indicates, there are multiple ways a lead can interfere with a TV, including causing endocarditis, a very dangerous blood disease (I know). If you have symptoms that might derive from lead interference, get an echo and a blood test.

Thanks Lonestar

by IAN MC - 2018-12-09 10:09:32

Thank you .... very interesting.    One of the first things I asked my cardiologist post-implant was " What are the downsides of shoving wires through my tricuspid valve,  will the valve still close OK ???

He was  slightly dismissive and then I had an ECHO .... surprise, surprise it showed slight leakage around the valve i.e. tricuspid regurgitation !  He was still fairly dismissive and said that it wasn't "clinically significant ".  I wonder !!

I wonder if slight fall offs in the ability to exercise could sometimes be due to the wires in the tricuspid valve causing valve malfunction and not necessarily due to chronotropic incompetence with the inevitable follow-up of various rate response  adjustments ??

I think it is a topic which EPs are not that happy about discussing.

Ian

lead interference

by Lonestar - 2018-12-09 14:33:32

Ian, This same thought occurred to me. SInce my PM installation 2 months ago, I have had 7 visits to program the rate-adaptive sensor and still don't feel like I am much ahead of where I was before the PM when I was dealing with bradycardia (I am an active athlete). SInce my recent echo shows "severe" TR, I now wonder whether the loss in cardio efficiency from the TR is offsetting any benefit I might be deriving from the PM. None of the techs have ever mentioned this, but I will be discussing with my cardio this week.

 

BTW---Do not take TR lightly! If this is happening because of damage as opposed to interference, you could be in serious trouble. I went through this with my mitral valve.

To Lonestar

by BarbD - 2018-12-09 14:58:51

Is your severe TR a result of the PM leads?  What are they planning to do about it - replace the valve?  I am trying to decide if I should proceed with a CRT-D and this is just another thing for me to worry about :-(

To BarbD

by Lonestar - 2018-12-09 15:56:06

Will learn more this coming week. Will update you. I had my mitral valve repaired 8 years ago and know that repair is preferable to replacement. If TR can be fixed by removing lead, then that is another approach to consider. On my first PM installation, EP tried to attach the ventricle lead to the bundle of His (inside the atrium). It failed and he then attached it inside the ventricle. He never fully explained why he tried the first apporach, but after reading about lead/valve interference, I think I know why.

Valve dysfunction

by Lonestar - 2019-04-11 22:31:30

In mid-February I had surgery to repair my highly dysfunctional (grade 4+ regurgitation) tricuspid valve. Surgeon (Cleveland Clinic) elected to also upgrade my PM to one with a footfall sensor and a breathing activity sensor. Surgeon told me the PM lead was not interfering with the TV. Six weeks out I feel more energetic than I have in years. Docs told me between the bradycardia and the TR I was headed south fast. I feel the new PM (Boston Scientific) is helping me more than previous one from St. Jude. I am hitting peaks (Fitbit) in the 140's even though the PM is set for 140. Not sure how that happens. I played basketball in the 90-degree heat today and enjoyed it. Surgeon also told me anybody who has had one valve issue can expect another one if they live long enough.

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