A recently published systematic review showed that there was marked improvement in tricuspid regurgitation grade after His bundle pacing for cardiac resynchronization therapy (CRT) and atrioventricular block (AVB) ( 10). The His-Purkinje system pacing (HPSP) including His bundle pacing (HBP) and left bundle branch pacing (LBBP) was a new physiological pacing method, which can prevent and treat heart failure by directly pacing the His bundle or the left bundle branch to maintain synchronous pacing ( 8, 9). When atrial fibrillation was combined with bradycardia, permanent pacemaker implantation was required ( 7). More than 90% of the patients after left-sided valve surgery had persistent atrial fibrillation (AF) ( 3), which could promote the dilatation of the tricuspid annulus, considered to be an important etiology of exacerbation of tricuspid regurgitation ( 6). Therefore, finding treatment strategies for preventing the progression of tricuspid regurgitation was the best hope for reducing the mortality and morbidity for these patients. Furthermore, the mortality of tricuspid valve surgery after the first left-sided valve surgery could reach 25%, and the three-year survival rate was only 19% ( 5). Although these patients could take another tricuspid valve surgery, the timing for surgery was difficult to determine, and many patients were delayed until the end-stage, losing the opportunities for surgery ( 4). The progressive aggravating tricuspid regurgitation gradually deteriorates the heart function and eventually leads to refractory right heart failure ( 3). Its incidence increased over time to more than 50% ( 2). Secondary tricuspid regurgitation was a common comorbidity in patients who had left-sided valve replacement. About 69,000 patients in China underwent valve replacement or repair operations every year ( 1). Left-sided valve surgery was a common procedure for left heart valve (mitral valve, and aortic valve) disease. In multivariate liner regression analysis, the pacing ratio ( β = 0.736, P = 0.037) was an independent determinant of tricuspid regurgitation velocity variation.Ĭonclusion: HPSP might reduce tricuspid regurgitation and improve cardiac function in patients with persistent atrial fibrillation after left-sided valve surgery. The NYHA classification of patients also improved ( P = 0.013). The cardiothoracic ratio of patients was significantly lower than that before implantation (0.61 ± 0.08 vs. The tricuspid regurgitation velocity significantly decreased (317 ± 74 cm/s vs. At 3-month follow-up, the tricuspid regurgitation grade was significantly lower than that before implantation ( P = 0.007). Three of them received HBP and five underwent LBBP. All patients had persistent atrial fibrillation. Eight patients who had undergone implantation of HPSP after left-sided heart valve replacement were enrolled in the study. Results: A total of 44 patients was retrospectively reviewed. Univariate and multivariate linear regression analysis of tricuspid regurgitation velocity were performed. Clinical data collected included electrocardiogram, pacing parameters, ultrasonic cardiogram parameters and chest x-ray at implantation and 3-month follow up. HPSP included His bundle pacing (HBP) or left bundle branch pacing (LBBP). The 3-year patient review focused on those who underwent permanent cardiac pacemaker implantation of HPSP after mitral valve and/or aortic valve replacement from Jan 1st, 2019 to Jan 1st, 2022. Methods: This study was a retrospective study. Our study aimed to investigate the effect of HPSP on tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery. His-Purkinje system pacing (HPSP) was a physiological pacing method, which could prevent and treat heart failure and might reduce tricuspid regurgitation. Atrial fibrillation was considered to be an important etiology of tricuspid regurgitation. 2Department of Ultrasound, Peking University International Hospital, Beijing, Chinaīackground & objective: Tricuspid regurgitation after left-sided valve surgery was a common and difficult problem.1Department of Cardiology, Peking University International Hospital, Beijing, China.Ning Wang 1,†, Tianyu Zhu 1,†, Yan Li 1, Guanliang Cheng 1, Yu Chen 1, Yuwei Fu 2, Xuezhi Chen 1* and Xiaohui Liu 1
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