Impact of pacemaker mode in patients with atrioventricular conduction disturbance after trans‐catheter aortic valve implantation

Takahashi, Masao; Badenco, Nicolas; Monteau, Jacques; Gandjbakhch, Estelle; Extramiana, Fabrice; Ureña, Marina; Karam, Nicole; Marijon, Éloi; Algalarrondo, Vincent; Teiger, Emmanuel; Lellouche, Nicolas

doi:10.1002/ccd.27594

Cited by 9 publications

(13 citation statements)

References 26 publications

(30 reference statements)

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“…In a recent study, pacemaker interrogations at outpatient follow‐up after TAVI revealed resolution of HDAVB in 61% of patients, with the vast majority of recovery occurring within one month . Similarly, other studies reported that only one‐third to a half of the patients who underwent pacemaker implantation for complete AV block exhibited persistent complete AV block …”

Section: Discussionmentioning

confidence: 90%

Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

Misumida

Pagath

Ogunbayo

et al. 2018

Cathet Cardio Intervent

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Objective We aimed to investigate the current practice patterns of permanent pacing, especially the timing of implantation, for high‐degree AV block (HDAVB) following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Background Comparative data regarding current practice patterns of permanent pacing for HDAVB between TAVI and SAVR is limited. Methods Using the National Inpatient Sample database, we identified patients who underwent TAVI or SAVR between 2012 and 2014. The incidence of HDAVB, the rate of permanent pacemaker implantation, and the timing of implantations were compared between TAVI and SAVR groups. Results We identified 33 690 and 202 110 patients who underwent TAVI and SAVR, respectively. HDAVB occurred in 3480 patients (10.3%) in the TAVI group and 11 405 patients (5.6%) in the SAVR group (P < 0.001). Among the patients who developed HDAVB, patients in the TAVI group were more likely to undergo permanent pacemaker implantation than those in the SAVR group (74.1% vs 64.7%; P < 0.001). The median interval from TAVI to pacemaker implantation was 2 days (interquartile range 1‐3 days) vs 5 days (interquartile range 3‐7 days) from SAVR to pacemaker implantation (P < 0.001). Among the patients who developed HDAVB, TAVI was associated with higher rates of permanent pacemaker implantation after adjusting for other comorbidities (odds ratio 1.41:95% confidence interval 1.13‐1.77; P = 0.003). Conclusions HDAVB occurred more commonly after TAVI compared to SAVR. HDAVB after TAVI compared to SAVR was associated with a higher rate of permanent pacemaker implantation at an earlier timing from the index procedure.

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Section: Discussionmentioning

confidence: 90%

Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

Misumida

Pagath

Ogunbayo

et al. 2018

Cathet Cardio Intervent

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“…Nine studies didn't provide information about the timing of PPI. 9,[18][19][20][21]24,25,27,29 The overall incidence of PPI reached 17% of the TAVI patients, ranging from 8.8% to 32% of the cases.…”

Section: Ppi Detailsmentioning

confidence: 99%

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

et al. 2021

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Objectives: Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI.Methods: We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted.Results: Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI.Conclusions: Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term. (JTCVS Open 2021;6:41-55)

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“…[ 44 ] As a significant portion of patients regain intrinsic conduction after implantation, follow up and pacemaker programming should promote spontaneous atrioventricular conduction when possible. [ 45 ] Irrespective of pacing burden after TAVR, it has been recognised that patients who require post-TAVR PPM implantation may be at higher risk of short- and long-term morbidity and mortality. [ 44 , 46 , 47 ] These higher rates of adverse events may be a signal of frailty in an otherwise vulnerable population, an increased risk of complications from pacemaker implantation itself or other unknown causes.…”

Section: Management Of Heart Block After Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

et al. 2021

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Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.

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Impact of pacemaker mode in patients with atrioventricular conduction disturbance after trans‐catheter aortic valve implantation

Cited by 9 publications

References 26 publications

Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

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