Effect of acute CORticosteroids on conduction defects after Transcatheter Aortic Valve Implantation: the CORTAVI study.
Humans
Transcatheter Aortic Valve Replacement
/ adverse effects
Bundle-Branch Block
/ diagnosis
Retrospective Studies
Prednisone
/ adverse effects
Aortic Valve Stenosis
/ diagnostic imaging
Cardiac Conduction System Disease
/ diagnosis
Arrhythmias, Cardiac
/ diagnosis
Atrioventricular Block
/ therapy
Pacemaker, Artificial
/ adverse effects
Adrenal Cortex Hormones
Aortic Valve
/ surgery
Treatment Outcome
Journal
Journal of cardiovascular medicine (Hagerstown, Md.)
ISSN: 1558-2035
Titre abrégé: J Cardiovasc Med (Hagerstown)
Pays: United States
ID NLM: 101259752
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
23
8
2023
pubmed:
6
7
2023
entrez:
6
7
2023
Statut:
ppublish
Résumé
Conduction abnormalities, requiring a permanent pacemaker (PPM), are the most common electrical complications after transcatheter aortic valve implantation (TAVI). The exact mechanism for conduction system defects is not yet clear. The local inflammatory process and edema are thought to play a role in the development of electrical disorders. Corticosteroids are effective anti-inflammatory and antiedematous agents. We aim to investigate the potential protective effect of corticosteroids on conduction defects after TAVI. This is a retrospective study of a single center. We analyzed 96 patients treated with TAVI. Thirty-two patients received oral prednisone 50 mg for 5 days after the procedure. This population was compared with the control group. All patients were followed up after 2 years. Of the 96 patients included, 32 (34%) were exposed to glucocorticoids after TAVI. No differences in age, preexisting right bundle branch block or left bundle branch block, or valve type were seen among patients exposed to glucocorticoids versus those who were unexposed. We observed no significant differences between the two groups in the overall frequency of new PPM implantations during hospitalization (12% vs. 17%, P = 0.76). The incidence of atrioventricular block (AVB) (STx 9% vs. non-STx 9%, P = 0.89), right bundle branch block (STx 6% vs. non-STx 11%, P = 0.71), and left bundle branch block (STx 34% vs. non-STx 31%, P = 0.9) was not significantly different between the STx and non-STx groups. At 2 years after TAVI, none of the patients had implanted PPM or had severe arrhythmias documented by 24-h Holter ECG or cardiac examination. Oral prednisone treatment does not appear to significantly reduce the incidence of AVB requiring acute PPM implantation after TAVI.
Identifiants
pubmed: 37409662
doi: 10.2459/JCM.0000000000001516
pii: 01244665-202309000-00013
doi:
Substances chimiques
Prednisone
VB0R961HZT
Adrenal Cortex Hormones
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
676-679Informations de copyright
Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
Références
Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364:2187–2198.
Khan SU, Riaz H, Khan MU, et al. Meta-analysis of temporal and surgical risk dependent associations with outcomes after transcatheter versus surgical aortic valve implantation. Am J Cardiol 2019; 124:1608–1614.
Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374:1609–1620.
Savino DC, McCarthy FH, Spragan DD, et al. Permanent pacemaker implantation following transcatheter aortic valve replacement. JACC Cardiovasc Interv 2017; 10:1276–1278.
Erkapic D, De Rosa S, Kelava A, Lehmann R, Fichtlscherer S, Hohnloser SH. Risk for permanent pacemaker after transcatheter aortic valve implantation: a comprehensive analysis of the literature. J Cardiovasc Electrophysiol 2012; 23:391–397.
Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Circ Cardiovasc Interv 2016; 9:e003635.
Tuzcu EM, Kapadia SR. Next generation valves: what are we looking for? J Am Coll Cardiol Intv 2016; 9:76–78.
Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol 2014; 64:129–140.
Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D. Transcatheter aortic valve replacement and cardiac conduction. Expert Rev Cardiovasc Ther 2019; 17:293–304.
Moreno R, Dobarro D, López de Sá E, et al. Cause of complete atrioventricular block after percutaneous aortic valve implantation: insights from a necropsy study. Circulation 2009; 120:e29–e30.
Leung DY1, Bloom JW. Update on glucocorticoid action and resistance. J Allergy Clin Immunol 2003; 111:3–22.
William YC, Zimmerman F, Hijazi ZM. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv 2005; 66:436–441.
Ghodsi S, Masoudkabir F, Hosseini Z, et al. Steroid use for recovery of advanced atrioventricular block immediately after VALvular surgery (SURVIVAL): a preliminary randomized clinical trial. J Cardiovasc Electrophysiol 2022; 33:575–585.
Brignole M, Auricchio A, Baron-Esquivias G, et al. European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA). 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). Europace 2013; 15:1070–1118.
Chevreul K, Brunn M, Cadier B, et al. Cost of transcatheter aortic valve implantation and factors associated with higher hospital stay cost in patients of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Arch Cardiovasc Dis 2013; 106:209–219.
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.
Sharma E, Chu AF. Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients. J Interv Card Electrophysiol 2018; 51:77–86.
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.
Costa G, Zappulla P, Barbanti M, et al. Pacemaker dependency after transcatheter aortic valve implantation: incidence, predictors and long-term outcomes. EuroIntervention 2019; 15:875–883.
Oestreich B, Gurevich S, Adabag S, et al. Exposure to glucocorticoids prior to transcatheter aortic valve replacement is associated with reduced incidence of high-degree AV block and pacemaker. Cardiovasc Revasc Med 2019; 20:328–331.
Bernhard B, Okuno T, Cicovic A, et al. Systemic corticosteroid exposure and atrioventricular conductance delays after transcatheter aortic valve implantation. Cardiovasc Revasc Med 2021; 37:1–6.