Tricuspid incompetence following permanent pacemaker implantation

Marc Klutstein, Jonathan Balkin*, Adi Butnaru, Michael Ilan, Amnon Lahad, David Rosenmann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Aim: Severe tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) has been described in small series of patients, though its incidence is not known. Methods: We retrospectively analyzed the data of 545 patients who underwent PPI and had Doppler echocardiograms performed before and after the procedure. We excluded 135 patients who had ≥moderate TI on the 1st Doppler echocardiogram. Results: Group 1 included 75 patients (18.3%) who had a >2 grades worsening of TI, and group 2 included 335 patients (82%) with <2 grade increase in TI after PPI. Patients in group 1 were 77 ± 7 years of age, versus 72 ± 10 years in group 2 (P < 0.001). There was no difference in left ventricular size and function. The TI gradient before PPI was higher in group 2 (25 ± 13 mmHg versus 19 ± 12 mmHg [P < 0.001]), though within the normal range in both groups. The mitral E/A ratio was 0.98 in group 1 versus 1.42 in group 2 (P < 0.001). The systolic TI gradient after implantation was 42 ± 12 mmHg in group 1, versus 33 ± 8 mmHg in group 2 (P < 0.001). Conclusion: Worsening of TI after PPI was not rare and was observed more often in older patients, with abnormal LV relaxation and who developed pulmonary hypertension after the procedure.

Original languageAmerican English
Pages (from-to)S135-S137
JournalPACE - Pacing and Clinical Electrophysiology
Issue numberSUPPL. 1
StatePublished - Mar 2009


  • Permanent pacing
  • Tricuspid insufficiency


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