Objective. Evaluation of the effect of primary implantation of a permanent pacemaker (PPM) on the degree of progression of tricuspid regurgitation (TR) in patients of older age groups with a permanent form of atrial fibrillation in the long-term follow-up period. Material and methods. A retrospective study was conducted. We analyzed electronic medical records of 1140 patients with permanent atrial fibrillation, who underwent primary implantation of a PPM (VVIR) for the period from 2008 to 2017 due to bradysystole or Frederick's syndrome. 148 case histories were selected according to established criteria. Using the same criteria, a comparison group of 657 patients was identified. Was carried out pseudorandomization using the 1:1 pair matching method by searching for the “nearest neighbor”. 104 pairs were formed, which were comparable in terms of the factors used in pseudorandomization. Multiple logistic regression was used to analyze the predictors of the onset/progression of TR. Results. In the preoperative period in both groups, the values of the left ventricular ejection fraction and enddiastolic volume did not differ and were within the normal range. Other ultrasonic parameters of the PPM group exceeded those of the control group. In the long-term follow-up period, the differences in echocardiographic parameters had a similar picture, and the values of the volumes of both atria, the size of the fibrous ring of the tricuspid valve (TV) and the value of the TR gradient had a clear negative trend in both groups. The prevalence of moderate and severe TR prevailed in the pacing group. It should be noted that in almost equal number of cases there was a regression of TR (in 18 (17.3%) of patients in the pacing group and in 16 (15.4%) in the control group, respectively). Based on the results of multiple logistic regression, a relationship was revealed between the fact of progression of TR in the long-term follow-up period and such independent predictors as gender and history of coronary artery disease. At the same time, the relationship between the fact of PPM implantation and the increase in the degree of TV insufficiency was not revealed. Conclusion. Tricuspid regurgitation in patients of older age groups with permanent atrial fibrillation progresses slightly in the long-term follow-up period, regardless of the primary implantation of the PPM.