Cardiac Implantable Electronic Device-related Tricuspid Regurgitation: Definitions, mechanisms, clinical impact, and management - A scoping review.

BACKGROUND: Cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as a clinically relevant entity, yet definitions, mechanisms, and management strategies remain heterogeneous. This scoping review aimed to systematically map existing evidence on definitions, incidence, mechanisms, predictors, clinical outcomes, and management of CIED-related TR. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, and CENTRAL without date restrictions. Studies reporting on TR in patients with pacemakers, implantable cardioverter defibrillators, or cardiac resynchronization therapy devices were included. Seventy-eight studies comprising 54,115 patients were identified and analyzed. RESULTS: Definitions and diagnostic criteria for TR varied widely across studies, and only a minority of studies systematically reported the underlying mechanism of TR. Incidence of TR development or progression after CIED implantation showed substantial variability (median 15.4 %, IQR 25.25 %), with higher rates observed in patients with pre-existing right heart disease. Mechanisms of TR were leaflet impingement or restriction, entanglement, perforation, and pacing-related right ventricular remodeling. Identified predictors of TR development or progression included pre-existing TR, right ventricular dysfunction, atrial fibrillation, and obesity. Management strategies comprised conservative therapy, transvenous lead extraction, surgical repair, and increasingly, transcatheter tricuspid valve interventions for severe TR. CONCLUSIONS: CIED-related TR represents a multifactorial condition with heterogeneous definitions and management strategies. Mechanism-based classification, standardized imaging approaches, and prospective studies are needed to better characterize TR entities, compare studies' outcomes, and investigate optimal management strategies in this growing patient population.