Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective.
TAVR
conduction abnormalities
pacing utilization
permanent pacemaker
transcatheter aortic valve implantation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
09
10
2021
received:
14
07
2021
accepted:
24
10
2021
pubmed:
3
11
2021
medline:
23
2
2022
entrez:
2
11
2021
Statut:
ppublish
Résumé
Permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve implantation (TAVI). The optimum timing of PPM implantation is still unclear as conduction abnormalities evolve and a balance needs to be struck between conservative delays in the hope of conduction recovery and overutilization of pacing. This study aimed to assess the safety and efficacy of early PPM implantation, without an observation period, among TAVI patients. This is a retrospective, observational study of 1398 TAVI patients. Clinical and pacing data were collected at baseline, 30 days and at a median of 15 (4-21) months post-TAVI. Study endpoints included PPM-related complications, pacing utilization and hospital length of stay. One hundred five patients (8.2%) required a PPM, of which 13 were implanted pre and 92 post-TAVI. Seventy-six percent required pacing for either second- or third-degree heart block. Time to implantation for post-TAVI PPM was 1 (0-3) day. Six patients experienced a pacing-related complication- lead displacement (n = 3), hematoma (n = 2), and device infection (n = 1). Pacing utilization defined as pacing >10% of the time or a pacing requirement at the time of the pacing check was demonstrated in 83% of patients. Multivariate analysis revealed complete heart block (CHB) was the only independent predictor of pacing utilization. Hospital length of stay for the post-TAVI PPM group was longer than the group without PPM (4 [2-8] vs. 3 [2-4] days; p < .001). Early PPM implantation in TAVI patients is safe and majority of patients require pacing in the short and mid-term.
Sections du résumé
BACKGROUND
BACKGROUND
Permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve implantation (TAVI). The optimum timing of PPM implantation is still unclear as conduction abnormalities evolve and a balance needs to be struck between conservative delays in the hope of conduction recovery and overutilization of pacing. This study aimed to assess the safety and efficacy of early PPM implantation, without an observation period, among TAVI patients.
METHODS
METHODS
This is a retrospective, observational study of 1398 TAVI patients. Clinical and pacing data were collected at baseline, 30 days and at a median of 15 (4-21) months post-TAVI. Study endpoints included PPM-related complications, pacing utilization and hospital length of stay.
RESULTS
RESULTS
One hundred five patients (8.2%) required a PPM, of which 13 were implanted pre and 92 post-TAVI. Seventy-six percent required pacing for either second- or third-degree heart block. Time to implantation for post-TAVI PPM was 1 (0-3) day. Six patients experienced a pacing-related complication- lead displacement (n = 3), hematoma (n = 2), and device infection (n = 1). Pacing utilization defined as pacing >10% of the time or a pacing requirement at the time of the pacing check was demonstrated in 83% of patients. Multivariate analysis revealed complete heart block (CHB) was the only independent predictor of pacing utilization. Hospital length of stay for the post-TAVI PPM group was longer than the group without PPM (4 [2-8] vs. 3 [2-4] days; p < .001).
CONCLUSIONS
CONCLUSIONS
Early PPM implantation in TAVI patients is safe and majority of patients require pacing in the short and mid-term.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-110Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Alkhouli M, Alqahtani F, Ziada KM, Aljohani S, Holmes DR, Mathew V. Contemporary trends in themanagement of aortic stenosis in the USA. Eur Heart J. 2020;41:921-928.
Costa Giuliano, Barbanti Marco, Tamburino Corrado. Trends in European TAVI practice. Cardiac Interventions Today. 2018.
Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation. 2017;136:1049-1069.
Toggweiler S, Stortecky S, Holy E, et al. The electrocardiogram after transcatheter aortic valve replacement determines the risk for post-procedural high-degree AV block and the need for telemetry monitoring. JACC Cardiovasc Interv. 2016;9:1269-1276.
Khatri PJ, Webb JG, Rodés-Cabau J, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158:35-46.
Urena M, Webb JG, Tamburino C, et al. Permanent pacemaker implantation after transcatheter aortic valve implantation impact on late clinical outcomes and left ventricular function. Circulation. 2014;129:1233-1243.
Van Eck JWM, Van Hemel NM, Zuithof P, et al. Incidence and predictors of in-hospital events after first implantation of pacemakers. Europace. 2007;9:884-889.
Eberhardt F, Bode F, Bonnemeier H, et al. Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity. Heart. 2005;91:500-506.
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: developed by the task force on cardiac pacing and cardiac resynchronization therapy of the european society of cardiology (ESC) with the special contribution of the european heart rhythm association (EHRA). Eur Heart J. 2021; 42(35):3427-3520.
Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013; 15:1070-118.
Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel. J Am Coll Cardiol. 2019;74:1086-1106.
Durko AP, Osnabrugge RL, Van Mieghem NM, et al. Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections. Eur Heart J. 2018;39:2635-2642.
D'Arcy JL, Coffey S, Loudon MA, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE population cohort study. Eur Heart J. 2016;37:3515-3522.
WHO. Life Expecatancy and Healthy life expectancy [Internet]. Available from: https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/life-expectancy-and-healthy-life-expecancy
Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new permanent pacemaker implantation following transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2018;11:301-310. https://www.sciencedirect.com/science/article/pii/S1936879817321994. Internet. Available from.
Muntané-Carol G, Philippon F, Nault I, et al. Ambulatory electrocardiogram monitoring in patients undergoing transcatheter aortic valve replacement: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77:1344-1356. https://www.sciencedirect.com/science/article/pii/S0735109721000723. Internet. Available from.
Sharma E, McCauley B, Ghosalkar DS, et al. Aortic valve calcification as a predictor of post-transcatheter aortic valve replacement pacemaker dependence. Cardiol Res. 2020;11:155-167. https://pubmed.ncbi.nlm.nih.gov/32494325. Internet. Available from.
Hamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015;8:1218-1228.
Junquera L, Freitas-Ferraz AB, Padrón R, et al. Intraprocedural high-degree atrioventricular block or complete heart block in transcatheter aortic valve replacement recipients with no prior intraventricular conduction disturbances. Catheter Cardiovasc Interv. 2020;95:982-990.
Vijayaraman P, Cano Ó, Koruth JS, et al. His-purkinje conduction system pacing following transcatheter aortic valve replacement. JACC Clin Electrophysiol. 2020;6:649-657.
Simms AD, Hogarth AJ, Hudson EA, et al. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2013;17:328-333.
Van Der Boon RMA, Van Mieghem NM, Theuns DA, et al. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding medtronic core valve system. Int J Cardiol. 2013;168:1269-1273.
Meduri CU, Kereiakes DJ, Rajagopal V, et al. Pacemaker implantation and dependency after transcatheter aortic valve replacement in the REPRISE III trial. J Am Heart Assoc. 2019;8:e012594.
Maree AO, Fitzgerald DJ. Variable platelet response to aspirin and clopidogrel in atherothrombotic disease. Circulation. 2007;115:2196-2207.