Intraprocedural high‐degree atrioventricular block or complete heart block in transcatheter aortic valve replacement recipients with no prior intraventricular conduction disturbances

Junquera, Lucía; Freitas‐Ferraz, Afonso B.; Padrón, Remigio; Silva, Iria; Ferreira‐Neto, Alfredo Nunes; Guimarães, Leonardo; Mohammadi, Siamak; Morı́s, César; Philippon, François; Rodés‐Cabau, Josep

doi:10.1002/ccd.28323

Cited by 25 publications

(18 citation statements)

References 28 publications

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“…20 Patients with transient complete or second-degree AV block have lower pacing utilization than those with persistent block; 33% of patients had a ventricular pacing rate >40% at 1 year. 19 Consistent with these findings, our study demonstrated that 8% of patients with CHB recovered and did not require pacing during the study period.…”

Section: Discussionsupporting

confidence: 88%

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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: Discussionsupporting

confidence: 88%

“…Eightyfive percent of patients had a ventricular pacing rate >40% at 1-year post-PPM. 19 High ventricular pacing burden can increase the risk of heart failure related hospitalization and prevent improvements in cardiac function. 15 However, with left bundle branch and His bundle pacing, electrical and mechanical synchrony can be maintained.…”

Section: Discussionmentioning

confidence: 99%

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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“…In this issue of the Journal , Junquera et al 2 tried to address this topic, reporting on the outcomes of 676 patients without prior conduction disturbances undergoing TAVR between 2007 and 2017. Balloon‐expandable Edwards valve and self‐expandable CoreValve system were implanted in most of the cases.…”

Section: Figurementioning

confidence: 99%

Transcatheter aortic valve replacement without previous conduction disturbances: The importance of preventing iatrogenic pacemaker implantation

Tarantini

Fabris

2020

Cathet Cardio Intervent

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Key Points• Transcatheter aortic valve replacement (TAVR) patients given pacemakers operating in mandatory DDD mode had more ventricular pacing, heart failure hospitalization, and mortality compared with AAI-DDD or VVI modes.• AV conduction disturbances are often transient after TAVR. Minimizing ventricular pacing where possible avoids the risk of pacemaker-induced cardiomyopathy.• Pacemaker specialists should be consulted for any TAVR patient with mild rhythm abnormalities given the high incidence of AV block.• Careful stratification of patients with conduction disturbances during TAVR may help identify the patients who will require an early permanent pacemaker implantation strategy. Despite continuous improvements in transcatheter aortic valve replacement (TAVR) in recent years, the occurrence of conduction disturbances has not significantly decreased over time and remains the most common complication, often leading to permanent pacemaker implantation (PPMI; Figure 1). Nevertheless, the impact of PPMI after TAVR is uncertain. 1 Baseline conduction disorders, such as right bundle branch block, are strongly associated with the risk of PPMI after TAVR. However, scant data exist about the outcomes of patients without preexisting conduction abnormalities developing intraprocedural conduction disturbances during TAVR. In this issue of the Journal, Junquera et al. 2 tried to address this topic, reporting on the outcomes of 676 patients without prior conduction disturbances undergoing TAVR between 2007 and 2017. Balloon-expandable Edwards valve and self-expandable CoreValve system were implanted in most of the cases. The intraprocedural conduction disturbances (high-degree atrioventricular block or complete heart block) rate was 7.4%, being persistent in the 64% of cases. In this group, the need for PPMI was about 97% (compared to 33.3% in the group suffering transient conduction disturbances), with a median time to PPMI of 1 day. Moreover, almost 7% of patients received a PPM because of the development of postprocedural conduction disturbances, within a median time of 5 days after TAVR. The overall incidence of PPMI before hospital discharge was 12.7%. Higher degree of transcatheter heart valve (THV) oversizing and implantation of the self-expandable CoreValve THV were the two procedural factors strongly associated with the occurrence of intraprocedural conduction disturbances. At 1-year follow up, the median pacing percentage was 98% in the PPM group with persistent intraprocedural conduction disturbances, compared to 37% of their counterparts with PPM and transient alterations. Among those patients with transient intraprocedural conduction disturbances who did not receive in-hospital PPMI, only one patient required PPMI during follow up. Finally, the left ventricular ejection fraction decreased over time in the PPM group with persistent intraprocedural conduction disturbances. On the contrary, the mortality rate did not significantly differ between the two groups.The most relevant takeaways are: first, when intrapro...

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Section: Introductionmentioning

confidence: 99%

“…Retrospective studies have shown that most (65-87%) of TAVI associated HAVB/CHB occur intra-procedure 14,15 and that majority (75%) of these patients ultimately require a PPM at discharge. 16 Thus, a simultaneous implant approach may save this subset of patients from undergoing a separate procedure and allow for a shorter length of stay. 17 Currently, clinical outcomes of leadless pacemakers in TAVI remains largely unknown due to scarcity of data, which are limited to case reports [18][19][20][21] and one case series.…”

Section: Introductionmentioning

confidence: 99%

Leadless Pacemaker with Transcatheter Aortic Valve Implantation: A Single Center Experience

Gao

Kherallah

Koetting

et al. 2022

Preprint

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Background The safety and efficacy of leadless pacemakers (LP) in transcatheter aortic valve implant (TAVI) patients is not well known due to paucity of data. Herein, we compared outcomes between leadless pacemakers to traditional dual chamber pacemakers (DCP) following TAVI. Methods A single-center retrospective study was conducted, including a total of 27 patients with LP and 33 patients with DCP after TAVI between November 2013 to May 2021. We compared baseline demographics, pacemaker indications, percent pacing, ejection fractions, and pacemaker related complication rates. Results Leading indications for pacemaker implant were complete heart block (74% LP, 73% DCP) and high degree atrioventricular block (26% LP, 21% DCP). No significant differences were observed between LP and DCP in device usage and ejection fraction at 1, 6, and 12 months. Within each pacemaker group, we did not observe a significant reduction in percent ventricular pacing or ejection fraction at follow up. Three DCP patients required rehospitalization for pocket related complications. Conclusion From this single-center study, TAVI patients appear to have comparable pacemaker usage and ejection fraction between LP and DCP groups, suggesting that LP may be a reasonable alternative where single ventricular pacing is indicated. Larger studies are required to validate these findings.

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Intraprocedural high‐degree atrioventricular block or complete heart block in transcatheter aortic valve replacement recipients with no prior intraventricular conduction disturbances

Cited by 25 publications

References 28 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

Transcatheter aortic valve replacement without previous conduction disturbances: The importance of preventing iatrogenic pacemaker implantation

Leadless Pacemaker with Transcatheter Aortic Valve Implantation: A Single Center Experience

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