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An under-recognised complication of permanent pacemakers is an increase in tricuspid regurgitation (TR) due to interference with the tricuspid valve apparatus, which can cause right ventricular (RV) dysfunction and right heart failure. We use a recent case to illustrate this phenomenon and highlight this as a differential diagnosis in patients with right heart failure and previously implanted pacemaker or defibrillator.
A 61 year old lady was referred for transthoracic echocardiography (TTE) after presenting with exertional dyspnoea. Two years previously she had undergone aortic valve replacement and subsequently required a permanent pacemaker for persistent junctional bradycardia. Clinical examination revealed an elevated venous pressure with prominent V waves and peripheral oedema. TTE showed RV dilatation and new severe TR (figure 1A). Trans-oesophageal echocardiography (TOE) was …