Risk Stratification for Pacemaker Implantation after Transcatheter Aortic Valve Implantation in Patients with Right Bundle Branch Block.
TAVI
permanent pacemaker implantation
right bundle branch block
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
22 Sep 2022
22 Sep 2022
Historique:
received:
22
08
2022
revised:
21
09
2022
accepted:
21
09
2022
entrez:
14
10
2022
pubmed:
15
10
2022
medline:
15
10
2022
Statut:
epublish
Résumé
Permanent pacemaker implantation (PPI) after transcatheter valve implantation (TAVI) is a common complication. Pre-existing right bundle branch block (RBBB) is a strong risk factor for PPI after TAVI. However, a patient-specific approach for risk stratification in this subgroup has not yet been established. We investigated TAVI patients with pre-existing RBBB to stratify risk factors for PPI and 1-year-mortality by detailed analysis of ECG data, RBBB morphology and degree of calcification in the implantation area assessed by computed tomography angiography. Between 2010 and 2018, 2129 patients underwent TAVI at our institution. Among these, 98 pacemaker-naïve patients with pre-existing RBBB underwent a TAVI procedure. PPI, because of relevant conduction disturbances (CD), was necessary in 43 (43.9%) patients. PPI was more frequently indicated in women vs. men (62.1% vs. 32.8%, Patients with RBBB undergoing TAVI have a high risk of PPI. Among this subgroup, female patients, male patients treated with self-expandable valve types, patients with high load/degree of non-coronary LVOT calcification and patients with atrial fibrillation need enhanced surveillance for CD after procedure.
Sections du résumé
BACKGROUND
BACKGROUND
Permanent pacemaker implantation (PPI) after transcatheter valve implantation (TAVI) is a common complication. Pre-existing right bundle branch block (RBBB) is a strong risk factor for PPI after TAVI. However, a patient-specific approach for risk stratification in this subgroup has not yet been established.
METHODS
METHODS
We investigated TAVI patients with pre-existing RBBB to stratify risk factors for PPI and 1-year-mortality by detailed analysis of ECG data, RBBB morphology and degree of calcification in the implantation area assessed by computed tomography angiography.
RESULTS
RESULTS
Between 2010 and 2018, 2129 patients underwent TAVI at our institution. Among these, 98 pacemaker-naïve patients with pre-existing RBBB underwent a TAVI procedure. PPI, because of relevant conduction disturbances (CD), was necessary in 43 (43.9%) patients. PPI was more frequently indicated in women vs. men (62.1% vs. 32.8%,
CONCLUSIONS
CONCLUSIONS
Patients with RBBB undergoing TAVI have a high risk of PPI. Among this subgroup, female patients, male patients treated with self-expandable valve types, patients with high load/degree of non-coronary LVOT calcification and patients with atrial fibrillation need enhanced surveillance for CD after procedure.
Identifiants
pubmed: 36233446
pii: jcm11195580
doi: 10.3390/jcm11195580
pmc: PMC9571112
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Circulation. 2012 Aug 7;126(6):720-8
pubmed: 22791865
Europace. 2012 Dec;14(12):1759-63
pubmed: 22733983
Clin Res Cardiol. 2014 Nov;103(11):912-20
pubmed: 24908338
Europace. 2017 Jun 01;19(6):1015-1021
pubmed: 28340150
Eur Heart J Cardiovasc Imaging. 2021 Sep 07;:
pubmed: 34491331
Med Eng Phys. 2013 Jan;35(1):125-30
pubmed: 22640661
JACC Cardiovasc Interv. 2014 Feb;7(2):128-136
pubmed: 24440024
Am Heart J. 2010 Mar;159(3):497-503
pubmed: 20211315
Radiology. 2013 Dec;269(3):650-69
pubmed: 24261496
Heart Rhythm. 2021 Dec;18(12):2040-2047
pubmed: 34400310
Pacing Clin Electrophysiol. 2021 Feb;44(2):240-246
pubmed: 33372688
Eur Heart J. 2019 Jul 14;40(27):2218-2227
pubmed: 31505615
JACC Cardiovasc Interv. 2018 Aug 13;11(15):1495-1505
pubmed: 30031719
PLoS One. 2021 Jun 16;16(6):e0253332
pubmed: 34133470
J Clin Med. 2021 Jun 19;10(12):
pubmed: 34205478
Clin Res Cardiol. 2015 Apr;104(4):351-62
pubmed: 25388650
Eur Heart J. 2021 Sep 14;42(35):3427-3520
pubmed: 34455430
Europace. 2019 Dec 1;21(12):1851-1856
pubmed: 31578544
Interv Cardiol. 2020 Jul 29;15:e11
pubmed: 32905123
Heart. 2020 Aug;106(16):1244-1251
pubmed: 32005676
J Am Coll Cardiol. 2009 Mar 17;53(11):982-91
pubmed: 19281931
J Am Coll Cardiol. 2014 Jul 15;64(2):129-40
pubmed: 25011716
Eur Heart J. 2019 Jul 14;40(27):2228-2230
pubmed: 31071207