Long-term evolution of pacemaker dependency after percutaneous aortic valve implantation with the corevalve prosthesis

Renilla, Alfredo; Rubín, José M.; Rozado, José; Morís, César

doi:10.1016/j.ijcard.2015.08.100

Cited by 11 publications

(4 citation statements)

References 9 publications

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“…The rate of pacemaker dependence reported in previous studies ranged from one-to two-thirds of patients during follow-up [33][34][35]. New-onset LBBB post-TAVR resolved in 45% (range 35-56%) in 30 days [6].…”

Section: Postprocedural Outcomementioning

confidence: 94%

Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement

Boonyakiatwattana

Maneesai

Chaithiraphan

et al. 2022

BMC Cardiovasc Disord

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Background Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs). Methods Consecutive patients who underwent TAVR during December 2009–March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University—Thailand’s largest national tertiary referral center—were enrolled. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively. Results A total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. Multivariate analysis revealed MS length ≤ 6.43 mm (adjusted odds ratio [aOR] 9.54; 95% CI 2.56–35.47; p = 0.001) and ∆MSID < 0 mm (adjusted odds ratio [aOR] 10.77; 95% CI 2.86–40.62; p = < 0.001) to be independent predictors of CD. The optimal ∆MSID cutoff value for predicting conduction disturbances was less than 0 mm (area under the receiver operating characteristic curve [AuROC]: 0.896). Conclusion This study identified MS length ≤ 6.43 mm and ∆MSID < 0 mm as independent predictors of CDs. ∆MSID < 0 was the strongest and only modifiable predictor. Importantly, we expanded the CD criteria to cover all spectrum of TAVR-related conduction injury to lower the threshold of this sole modifiable risk. The optimal ∆MSID cutoff value was < 0 mm. Trial registration: TCTR, TCTR20210818002. Registered 17 August 2021—Retrospectively registered, http://www.thaiclinicaltrials.org/show/TCTR 20210818002.

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Section: Postprocedural Outcomementioning

confidence: 94%

Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement

Boonyakiatwattana

Maneesai

Chaithiraphan

et al. 2022

BMC Cardiovasc Disord

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“…In these small cohorts, recovery of conduction was found in 52-71% of patients. Other studies have provided information about the recovery of conduction after TAVI by performing interrogations of the implanted pacemakers [ 21 , 36 , 60 - 62 ]. Although heterogeneity in defining pacemaker dependency and in the timing of pacemaker interrogation must be acknowledged, these studies provide further evidence that a significant proportion of conduction anomalies resolve during follow up period.…”

Section: Incidence Of Conduction Anomalies After Tavimentioning

confidence: 99%

“…QRS duration after TAVI minus duration before TAVI) with an optimal cut off of 38 milliseconds. In the subgroup of patients with new onset LBBB, when data of pre TAVI electrophysiological study were excluded, the only predictor of HAVB was the HV interval after TAVI, with an optimal cut off of ≥ 65 milliseconds [ 62 ].…”

Section: Predictors Of Lbbb and Of Need Ppimentioning

confidence: 99%

Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status

Russo

Potenza

Casella

et al. 2019

CCR

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Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients. However since the aortic valve has close spatial proximity to the conduction system, conduction anomalies are frequently observed in TAVI. In this article, we aim to review the key aspects of pathophysiology, current incidence, predictors and clinical association of conduction anomalies following TAVI.

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“…Results of the investigations concerning patients with PPM implanted after TAVI are not consistent. Nonetheless, a significant decrease in pacing dependency is observed [57, 58]. The lowest ventricular pacing rate was observed in patients in whom PPM implantation was performed due to bundle branch blocks [35, 55].…”

Section: Treatment Approachmentioning

confidence: 99%

Conduction disturbances after transcatheter aortic valve implantation procedures – predictors and management

Wilczek¹,

Reguła²,

Bujak³

et al. 2016

pwki

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Transcatheter aortic valve implantation (TAVI) has become a safe and efficient alternative to cardiac surgery in patients with severe aortic stenosis. In many countries the number of performed TAVI procedures equals the number of surgical implantations. Indications for TAVI are becoming more liberal, allowing a wider spectrum of patients to benefit from the advantages of transcatheter therapy. Due to its invasive nature, TAVI is associated with some complications such as conduction disturbances. Although these disturbances are usually not lethal, they have a great influence on patients’ state and long term-survival. The most relevant and common are His’ bundle branch blocks, atrioventricular blocks, and need for permanent pacemaker implantation. With the frequency at 10% to even 50%, conduction abnormalities are among the most important TAVI-related adverse events. Risk factors for conduction disturbances include age, anatomy of the heart, periprocedural factors, type of implanted valve, and comorbidities. Severity of occurring complications varies; therefore selection of a proper treatment approach is required. Considered as the most effective management, permanent pacemaker implantation turned out to negatively influence both recovery and survival. Moreover, there is no expert consensus on use of resynchronization therapy after TAVI. In this paper, the authors present a comprehensive analysis of the most common conduction disturbances accompanying TAVI, factors related to their occurrence, and treatment approach.

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Long-term evolution of pacemaker dependency after percutaneous aortic valve implantation with the corevalve prosthesis

Cited by 11 publications

References 9 publications

Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement

Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement

Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status

Conduction disturbances after transcatheter aortic valve implantation procedures – predictors and management

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