New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device.

BACKGROUND

Post-procedural conduction disorders following transcatheter aortic valve replacement (TAVR) still remain frequent, especially using the largest self-expandable device (Medtronic Corevalve Evolut R

METHODS

We performed a dual centre analysis of 130 of 182 consecutive patients treated with STHV-34, further stratified into subjects without post-procedural PPM (-PPM n=100, 76.9%) and those requiring post-procedural PPM (+PPM n=30, 23.1%). These events were further analyzed by univariate and multivariate analysis according to several underlying conditions.

RESULTS

Multivariate analysis only depicted previous right bundle branch block [RBBB; OR: 11.52 (2.63-50.44), P=0.001] and eccentricity index of the left ventricular outflow tract (LVOT-EI) >0.3 [OR: 3.07 (1.22-7.77), P=0.018] as highly predictive for PPM-need, being also confirmed by c-statistics [area under the curve (AUC) =0.68; 95% confidence interval (CI): 0.57-0.80; P=0.0025]. There was only moderate correlation of implantation depth over the MSL in terms of PPM prediction (r=0.23; P<0.0001).

CONCLUSIONS

This study offers new insights into potential PPM predictors using the STHV-34: previous RBBB and a pronounced LVOT-EI were independent predictors of PPM, while most of the previously reported determinants failed to predict PPM-need including MSL and implantation depth.

Informations de copyright

2020 Cardiovascular Diagnosis and Therapy. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt-20-680). Dr. VV, DF, CJ and TZ reports grants, personal fees, non-financial support and other from EDWARDS, grants, personal fees, nonfinancial support and other from MEDTRONIC, outside the submitted work. The other authors have no conflicts of interest to declare.