Impact of Permanent Pacemaker Implantation on Clinical Outcome Among Patients Undergoing Transcatheter Aortic Valve Implantation

Buellesfeld, Lutz; Stortecky, Stefan; Heg, Dik; Hausen, Sven; Mueller, Ralf; Wenaweser, Peter; Pilgrim, Thomas; Gloekler, Steffen; Khattab, Ahmed A.; Huber, Christoph; Carrel, Thierry; Eberle, Balthasar; Meier, Bernhard; Boekstegers, Peter; Jüni, Peter; Gerckens, Ulrich; Grube, Eberhard; Windecker, Stephan

doi:10.1016/j.jacc.2012.03.054

Cited by 197 publications

(112 citation statements)

References 28 publications

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“…The evolution of conduction disorders took place over a period of 7 days after implantation. In our series, complete atrioventricular block was seen in 13.3%, while 8.9% suffered from type II second-degree atrioventricular block; thus, 22.2% of the patients developed an indication for permanent pacemaker implantation corroborating previous findings (27)(28)(29)(35)(36)(37)(38)(39). Their intracardiac measurements revealed that the occurrence of first-degree atrioventricular block was predominantly due to the prolongation of HV interval, which might be prognostically relevant (40).…”

Section: Conduction Disorderssupporting

confidence: 89%

ECG Abnormalities after Transcatheter Aortic Valve Implantation

Akın¹,

Nienaber²

2014

Arch Cardiovasc Imaging

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Transcatheteraortic valve implantation, first introduced in 2002, has been established as an alternative modality for patients deemed not suitable for open-heart surgery. The anatomical vicinity of the atrioventricular node and the His bundle to the non-coronary and rightcoronary aortic cusps predisposes patients to conduction abnormalities in case of severe calcification or mechanical trauma during valve implantation. However, the two evaluated valves (CoreValve and Edwards SAPIEN valve) have different rates of these complications, mainly driven by their respective geometry. Currently, there is ongoing evaluation of the true rate of conduction disorders and their clinical relevance or durability. The initial experience of fatal outcomes with conduction disorders such as complete atrioventricular block has increased the rate of subsequent pacemaker implantation up to 50%. However, prophylactic pacemaker implantation is associated with several possible complications. Thus, there is a need for further data from large-scale series taking into account the true rate of clinically relevant conduction disorders.Keywords:Heart Valve Prosthesis Implantation; Atrioventricular Block; Bundle-Branch Block; Pacemaker; Artificial; Bundle of His Implication for health policy/practice/research/medical education: The transcatheter aortic valve implantation is an established tool for the treatment of multimorbid patients suffering from severe symptomatic aortic valve stenosis. However, it is much more associated with with pacemaker dependence as compared to classic open aortic valve surgery. Within this review we try to explain the differences between the interventional procedure and the open surgical procedure as well as the difference between different vlave types.

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Section: Conduction Disorderssupporting

confidence: 89%

ECG Abnormalities after Transcatheter Aortic Valve Implantation

Akın¹,

Nienaber²

2014

Arch Cardiovasc Imaging

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“…30 It is somewhat controversial whether PPI adversely affects long-term outcome and mortality after TAVR. 31 Data from the PARTNER study and registry demonstrate that PPI is associated with a longer hospital stay and risk of subsequent hospitalization. 28 The data also reveal an increase in the composite endpoint of death and repeat hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Lüke¹,

Huntsinger²,

Carlson³

et al. 2016

JICRM

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“…21 While permanent pacemaker implantation does not appear to adversely affect short or intermediate clinical outcomes, 22 longer-term studies are required to assess the true impact of conduction abnormalities.…”

Section: Conduction Abnormalitiesmentioning

confidence: 99%

Transcatheter aortic valve implantation – what the general physician needs to know

Ruparelia

Prendergast

2015

Clinical Medicine

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with a 5-10% risk of major adverse perioperative events and a mortality of up to 20% at one year. 5 Given this prohibitively high surgical risk, these patients have historically refused or been denied surgery with no alternative treatment option.Following the first successful human implantation in 2002, 6 transcatheter aortic valve implantation (TAVI) has rapidly developed over the past few years and is now the established treatment option for inoperable or high-risk surgical patients with severe symptomatic AS. 7 In this article, we will summarise the current evidence base and discuss factors that need to be taken into account by the general physician when considering TAVI as a treatment option, including practical aspects and future directions. Current evidenceFollowing the first successful TAVI in 2002, 6 the feasibility, efficacy and safety of the procedure were subsequently confirmed in a number of single-and multi-centre registries. 8 The Placement of AoRTic TraNscathetER Valves (PARTNER) trials were the first prospective randomised studies to compare outcomes of TAVI using the balloon-expandable (BE) Edwards Sapien valve (Edwards LifeSciences, Irvine, CA, USA) with medical management in inoperable patients 9 (cohort B) and with SAVR in patients of high surgical risk (cohort A). 10 When compared with medical therapy (plus balloon aortic valvuloplasty as required), TAVI resulted in a significant reduction in one-year mortality (30.7 vs 50.1%) that was maintained at three-year follow-up (54.1 vs 80.9%). 11 When TAVI was compared with SAVR in high-risk individuals, all-cause mortality was slightly lower with TAVI at 30 days (3.4 vs 6.5%, p=0.07) but comparable three years following implantation (44.2 vs 44%) with long-term symptomatic improvement sustained in both groups. 12 Of late, results of two more contemporary TAVI trials were reported. The non-randomised CoreValve US extremerisk pivotal trial described outcomes of TAVI using the self-expandable (SE) Medtronic CoreValve (Medtronic Inc., Minneapolis, MN, USA) in inoperable patients and demonstrated the efficacy of this treatment option with a 40% reduction in the one-year combined endpoint of all-cause mortality and stroke. 13 The randomised CoreValve US high-risk pivotal trial compared the same device with SAVR in patients deemed to be of high surgical risk. For the first time, TAVI was shown to be associated with a mortality benefit (14.2 vs 19.1%; p<0.0001 for non-inferiority and p=0.04 for superiority).With an increasingly elderly population, the incidence of aortic stenosis (AS) is rising. While surgical aortic valve replacement remains the gold standard treatment for patients with severe symptomatic AS, transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for patients who are inoperable or high surgical risk. TAVI has been shown to be associated with a clear mortality benefit when compared with medical therapy and to be at least as good as surgical aortic valve replacement in this patient group. The last few years h...

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Impact of Permanent Pacemaker Implantation on Clinical Outcome Among Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract: Although prognosis remains impaired compared with an age-, sex-, and origin-matched standardized population, periprocedural PPM implantation does not seem to affect clinical outcomes adversely among patients undergoing transfemoral TAVI.

Cited by 197 publications

References 28 publications

ECG Abnormalities after Transcatheter Aortic Valve Implantation

ECG Abnormalities after Transcatheter Aortic Valve Implantation

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

Transcatheter aortic valve implantation – what the general physician needs to know

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