Significant tricuspid regurgitation, defined as at least moderate, in the presence of leads in the right ventricle (CIEDs) has an incidence ranging from 7.2% to 44.7%; the His bundle pacing appears to be associated with a lower incidence of the onset or worsening of tricuspid regurgitation. Our study evaluate the severity of tricuspid regurgitation, its worsening by at least one grade compared to baseline, and the relationship between catheter location/type and the severity of regurgitation. From June 2023 to March 2024, a total of 71 patients (age 75 ±7 years) attending our hospital, indicated for pacemaker implantation due to complete AVB (60%) or SSS (40%) (Table 1), underwent His bundle pacing (HBP). In the population, only a 13% increase of at least one grade in tricuspid regurgitation was recorded at the 12-month ecocardiographic follow-up compared to baseline (Table 3), which was lower than in the two large reviews by Tatum R et al. and Offen S et al., where subjects with traditional pacing implant were assessed, and the increase ranged between 20% and 24%. Regarding the correlation between the grade of tricuspid regurgitation and the catheter site/type, since supranular pacing was very rarely represented (1% supranular vs 99% underanular), a comparison with the underanular technique could not be made. Considering the two types of catheters used (4F vs 6F), no correlation with the worsening of regurgitation (Table 2). The results obtained may be linked both to a more physiological stimulation of the right ventricle, and to a lower incidence of direct damage to the valvular apparatus with the 'Prolapsing technique' used for the stimulation. In conclusion, although with the limitations of the study, particularly its small statistical size and the short follow-up period, it can be concluded that His bundle pacing associated with the 'prolapsing technique' may have a favorable impact on the evolution of 'CIEDs'-related tricuspid regurgitation.
Associazione Nazionale Medici Cardiologi Ospedalieri
