Aortic Valve Calcification as a Predictor of Post-Transcatheter Aortic Valve Replacement Pacemaker Dependence

Sharma, Esseim; McCauley, Brian; Ghosalkar, Dhairyasheel; Atalay, Michael K.; Collins, Scott; Parulkar, Anshul; Sheikh, Wasiq; Ahmed, Malik Bilal; Chu, Antony

doi:10.14740/cr1011

Cited by 16 publications

(9 citation statements)

References 41 publications

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“…Our rates of pacing utilization differ to reported rates of pacing dependency; 32%−44% at 30 days 17,22,23 and 50% at 1-year post-TAVI. 23 It is important to acknowledge that the balance between patient safety and the waiting period before PPM implant can never be totally robust, as some patients may recover cardiac conduction much later post-TAVI and it is inappropriate to program the PPM to function well below physiological parameters.…”

Section: Discussioncontrasting

confidence: 99%

“…21,22 Although our understanding of conduction abnormalities that develop after valve interventions has improved, predicting who will need pacing and when it will be required remains a challenge, as conduction abnormalities can change over time. 17 Multivariate analysis revealed only CHB, as an independant predictor of pacing utilization. Further studies are required to confirm our findings and identify other predictors that influence pacing utilization.…”

Section: Discussionmentioning

confidence: 97%

“…11 Several studies have stratified the pre-TAVI risk of needing a PPM based on ECG (RBBB being the most consistently identified), anatomical and procedural criteria. 3,7,17,18 Instead of validating these risk factors, this study evaluated the safety and effectiveness of a management strategy (early PPM implantation) in a high-volume tertiary center. Our practice reflects a growing trend among centers and is in keeping with a recent expert consensus and guidelines for procedural/persistent CHB that recommends earlier PPM implantation.…”

Section: Discussionmentioning

confidence: 99%

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Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective

Patel

Lim

Pavithran

et al. 2021

Pacing Clinical Electrophis

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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: 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: 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:Early PPM implantation in TAVI patients is safe and majority of patients require pacing in the short and mid-term.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective

Patel

Lim

Pavithran

et al. 2021

Pacing Clinical Electrophis

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“…A total of 31 261 patients undergoing TAVR from 78 studies were included, of these 6212 (19.8%) received PPM, while 25 049 (80.2%) did not require a PPM. 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

Section: Resultsmentioning

confidence: 99%

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

Ullah

Zahid

Zaidi

et al. 2021

JAHA

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Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.

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“…Увеличение продолжительности искусственного кровообращения часто связано с более тяжелой дегенерацией АК, требующей интенсивной декальцификации, ассоциированной с травмой ПСС. Аналогичные данные были получены в ряде исследований при ПАК и TИАК: выраженный кальциноз и увеличенное время искусственного кро-вообращения являлись предикторами развития стойких АВ-блокад, потребовавших имплантацию ЭКС [6,12,26,27].…”

Section: таблица 2 нарушения проводящей системы сердца на электрокард...unclassified

Analysis of cardiac conduction disorders in adult patients in the early postoperative period after Ozaki surgery

Makarova

Дурманов

Batrakov

et al. 2022

Vestnik aritmologii

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Purpose. To assess the disorders of the cardiac conduction system (CCS) that occurred in the early postoperative period after aortic valve (AV) replacement by the Ozaki method.Methods. The study included 256 patients after a successfully performed Ozaki procedure. Patients with a history of open cardiac surgery, with an implanted pacemaker, with permanent atrial fibrillation, with simultaneous Ozaki surgery with correction of another pathology, in case of repeated surgery on AV in the next six months, with lethal outcome, under the age of 18 years, when it is impossible to analyze the CCS dynamics were excluded. The mean age was 57.9±11.1 years, the male sex was 119 people (46.5%), the body mass index was 29.7±5.5 kg/m2 , diabetes was observed in 40 patients (15.6%), anamnesis of CCS disorders in 10 (3.9%), CCS disorders on the baseline electrocardiogram (ECG) in 32 (12.5%). Conduction abnormalities were assessed according to the anamnesis and the results of daily ECG recording.Results. In the early postoperative period, CCS disorders were registered in 35 patients (13.7%), of whom 27 (10.6%) had their first occurrence, and 8 (3.1%) had previously existed. By the time of discharge, persistent CCS disorders (which occurred for the first time and in the case of progression of pre-existing blocks) remained in 11 (4.3%): 8 (3.1%) had bundle branch blocks, 3 (1.2%) had atrioventricular blocks that required implantation of a permanent pacemaker. Patients with pacemaker had initial conduction abnormalities. The most frequent dysfunction of the CСS was the left bundle branch block (LBBB) (45.5%). We analyzed 14 variables as predictors of the onset or progression of persistent CCS disorders. Two independent predictors were identified - the presence of conduction abnormalities on the baseline ECG and the time of cardiopulmonary bypass. In patients with persistent conduction disturbances in the postoperative period, CCS disorders on the baseline ECG were more common - 36.4% compared with patients without CCS disorders after surgery - 11.4% (p=0.035) and there was a longer duration of cardiopulmonary bypass 140.6±41.1 min. and 122.4±26.1 min. respectively (p=0.03).Conclusion. The most frequent disorder of the conduction was the LBBB. None of the first dysfunctions of CCS led to the implantation of the pacemaker. The presence of initial ECG conduction disturbances and the time of cardiopulmonary

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Aortic Valve Calcification as a Predictor of Post-Transcatheter Aortic Valve Replacement Pacemaker Dependence

Cited by 16 publications

References 41 publications

Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective

Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

Analysis of cardiac conduction disorders in adult patients in the early postoperative period after Ozaki surgery

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