Objectives: Tricuspid valve insufficiency is not a rare finding in patients with implantable right ventricular lead but there have been some debates about clinical implication of implantable lead associated tricuspid regurgitation. We aimed to investigate incidence and impact of tricuspid regurgitation on clinical outcomes in patients with permanent pacemaker. Methods: We enrolled 118 patients (mean age 66.7짹9.8, male 54.6%) with diagnosed sick sinus syndrome and underwent permanent pacemaker implantation from 2000 to 2008 in CNUH. We checked baseline clinical characteristics, laboratory findings and echocardiographic data. We compared frequency of death, stroke and hospitalization due to congestive heart failure symptom according to presence of tricuspid regurgitation more than grade II in echocardiography. Results: Significant tricuspid regurgitation (TR more than grade II) was observed in 26 patients (22%). Patient with VVI type pacemaker has higher incidence of significant TR compared with patient with DDD type pacemaker (18.6% vs 53.6%, p=0.02). When we divided whole patients into two groups according to presence of significant TR, there was no statistically significant difference in baseline clinical characteristics, laboratory and baseline echocardiography data between groups. In follow up echocardiography, patients with significant TR had larger left atrial diameter than patients without significant TR (45.7mm vs 41.4mm, p=0.022). During clinical follow up, hospitalization due to heart failure was observed more frequently in TR group (28.0% vs 6.7%, p=0.013) but there was no difference in frequency of death and stroke. In survival analysis adjusted by multivariate Cox regression, tricupspid regurgitation was independent predictor of hospitalization due to congestive heart failure (p=0.045, HR=3.233) Conclusion : Tricuspid insufficiency was frequently observed in patient with permanent pacemaker and it was associated with higher hospitalization rate due to congestive heart failure symptom and larger left atrial size.