Tricuspid Regurgitation Following Implantable Cardiac Defibrillator (Icd) Lead Extraction

1Good Samaritan Hospital, Cincinnati, OH
2Good Samaritan Hospital, Cincinnati, OH
3Good Samaritan Hospital, Cincinnati, OH
4Good Samaritan Hospital, Cincinnati, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 494

Case Presentation:

The major cardiac complications associated with lead extraction are cardiac and superior vena cava perforation. There are few reports of tricuspid regurgitation (TR) as a complication of extraction of chronically implanted leads. Most cases of TR occur during implantation when tined leads become entrapped in the tricuspid valve apparatus. An 83‐year‐old white male with a history of ischemic cardiomyopathy, COPD, paroxysmal atrial fibrillation (A‐fib), and DVT was referred to an electrophysiologist (EP) for upgrade of ICD to biventricular (Bi‐V) ICD. He had an ICD placed 3 years ago for cardiomyopathy. A 2‐D ECHO showed LVEF of 35%–40% with moderate to severely decreased LV function, mild MR and TR. ICD was removed with excimer laser and a Bi‐V ICD was implanted. Patient initially felt better but after couple of days started to have shortness of breath (SOB). He was started on Lasix. A month later he was reevaluated by EP for continued SOB. His Bi‐V ICD was found to be functioning normally. After another month he went into A‐fib. He was started on amiodarone and then successfully cardioverted 2 weeks later. CXR showed new small bilateral pleural effusions. Patient also developed ascites along with worsening dyspnea. He was hospitalized. A 2‐D echocardiogram showed LVEF of 50%–55%, RV and RA moderately dilated. Moderate to severe TR was noted. No pericardial effusion was found. A right heart catheterization demonstrated moderate pulmonary hypertension and evidence of severe TR.

Discussion:

Partial rupture of the tricuspid apparatus and significant regurgitation may occur following uneventful extraction of leads. The frequency of this complication might be underestimated. Traumatic lesions should be suspected in patients developing unexplained heart failure late after an extraction procedure. Although lead extraction can be done manually the excimer laser is often required. A recent study reported a 96.5% lead removal success with this technique and a major complication rate of 1.4%. The valve could be damaged by this technique. Another study showed that post–laser extraction TR had an incidence of 9.4%.

Conclusions:

In our patient there was a significant increase in TR 4 months after lead extraction, which raises the possibility of damage to the valve during an otherwise benign procedure.

To cite this abstract:

Raeissi S, Rashid N, Ghazi F, Wilson J. Tricuspid Regurgitation Following Implantable Cardiac Defibrillator (Icd) Lead Extraction. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 494. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/tricuspid-regurgitation-following-implantable-cardiac-defibrillator-icd-lead-extraction/. Accessed November 11, 2019.

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