Progression of Tricuspid Regurgitation After Cardiac Implantable Electronic Device Implantation and Its Impact on Mortality and Hospitalization: A Single‐Center Cohort Study

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Abstract
Introduction: Tricuspid regurgitation (TR) progression is a recognized complication of cardiac implantable electronic device (CIED) implantation, yet its prognostic impact on long‐term clinical outcomes remains incompletely defined. Methods and Results: In this single‐center retrospective cohort, 303 patients undergoing CIED implantation between 2005 and 2023 were followed for a median of 4.8 years. TR severity was assessed echocardiographically at baseline and 12 months. The primary endpoint was TR progression (≥ 1‐grade worsening); secondary endpoints were all‐cause mortality, cardiovascular hospitalization, their composite, and progression to severe TR, analyzed by Kaplan–Meier and Cox regression. TR progressed in 103 patients (34.0%), regressed in 33 (10.9%), and remained stable in 167 (55.1%), a net rightward shift ( p < 0.001). Progression differed by device type ( p = 0.031): among the larger subgroups, VVI‐ICD showed the greatest net progression (31.8% worsened vs. 6.9% improved; p < 0.001) and CRT‐D the highest regression (18.8%). During follow‐up, 67 patients (22.1%) died and 164 (54.1%) were hospitalized. Overall TR progression was not independently associated with mortality (HR 1.118, p = 0.693) but independently predicted cardiovascular hospitalization (HR 1.640, p = 0.003) and the composite endpoint (HR 1.480, p = 0.014). On unadjusted analysis, progression specifically to severe TR ( n = 15) was associated with increased mortality (HR 1.99, p = 0.024) and cardiovascular hospitalization (HR 2.45, p < 0.001). Conclusion: TR progression occurs in approximately one‐third of CIED recipients within the first year and independently predicts cardiovascular hospitalization. Progression to severe TR identifies a higher‐risk subset, supporting routine post‐implant echocardiographic surveillance.

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