Incidence of Conduction Disorders and Requirements for Permanent Pacemaker After Transcatheter Aortic Valve Implantation

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or nonoperable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3 rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve ® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM.

Incidence and Predictors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Procedures: Data of The Netherlands Heart Registration (NHR)

“…However, Luke and colleagues [13], in their population of 140 patients receiving a selfexpandable prosthesis, showed a higher rate of PM in those of male gender, but without statistical significance. Indeed, as male patients have a larger aortic annulus [14], we can speculate that oversizing is applied less frequently in men, which may have a positive impact on atrioventricular conduction [6].…”

“…To some extent, the predictive factors of post-TAVI PM have been studied in the TAVI population, including pre-procedural right bundle branch block or left bundle branch block, use of self-expanding bioprosthesis, and valve implantation depth [3,5]. Larger aortic annulus, male sex, and intra-procedural AVblock have also been found to be independent predictive factors of peri-operative PM [3,6]. Despite the rather frequent incidence of post-TAVI PM, the available data in this setting are limited and inconsistent, mainly derived from relatively small population studies, registry data, and non-randomized trials [1,7].…”

O implante de valva aórtica transcateter no tratamento da estenose aórtica: perspectivas e desafios / Transcatheter aortic valve implantation in the treatment of aortic stenosis: perspectives and challenges

“…Já a EA sintomática resulta em uma expectativa de vida de <3 anos e sua forma grave está associada à alta morbimortalidade, paralelamente, a expectativa de vida de pacientes com estenose e concomitante insuficiência cardíaca e distúrbios do ritmo, é estimada em menos de 2 anos. (WANG D, et al, 2020;LOPES MACQ, et al, 2020;SANTOS MC, et al, 2019) As três principais causas na população geral que a EA tem origem são: a) calcificação de uma válvula trifásica normal; b) calcificação de uma válvula bicúspide ou unicúspide congenitamente anormal; e c) doença valvar reumática. Além destas, doenças como problemas do metabolismo mineral ou LES também podem contribuir para o desenvolvimento da estenose aórtica (HARKY A, et al, 2019).…”

“…A troca valvar aórtica está relacionada a baixa mortalidade quando realizada em pacientes sem comorbidades graves. Contudo, pelo menos 30% dos sintomáticos pacientes com EA grave não são operados pela presença de comorbidades, disfunção ventricular ou idade avançada (SANTOS MC, et al, 2019). Uma forma de tratamento menos invasiva, que seria uma alternativa atraente para pacientes com alto risco cirúrgico ou considerados 'inoperáveis', seria o implante de valva aórtica transcateter (TAVR ou TAVI, do inglês Transcatheter Aortic Valve Replacement) (CELIS D, et al, 2020;ZUNGUR M, 2019).…”