Novel Strategy for Patients With Pre-Existing Right Bundle Branch Block

Miyamoto, Junichi; Ohno, Yohei; Sakai, Katsuaki; Murakami, Tsutomu; Horinouchi, Hitomi; Hasegawa, Misaki; Natsumeda, Makoto; Torii, Sho; Okada, Kazutaka; Cho, Yasunori; Urimoto, Genya; Ito, Kenji; Nakazawa, Gaku; Ikari, Yuji

doi:10.1016/j.jcin.2020.06.005

Cited by 6 publications

(9 citation statements)

References 3 publications

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“…Transjugular ICE enables real-time direct visualization of the MS during THV implantation, and thus the operator can adjust the landing point at the MS with a repositionable THV. 20 It is not impossible to evaluate the MS by the transfemoral ICE; however, the transjugular ICE is more preferable because the transfemoral ICE requires the catheter to be inverted at the right atrium with the presented images unstable, which may make continuous visualization of MS challenging in some cases (Figure S5). Although some cases showing the feasibility of ICE were recently reported from Japan, 20 no comparative study is available on the impact of ICE-guided TAVI on the reduction of subsequent conduction disturbances.…”

Section: Discussionmentioning

confidence: 99%

“…20 It is not impossible to evaluate the MS by the transfemoral ICE; however, the transjugular ICE is more preferable because the transfemoral ICE requires the catheter to be inverted at the right atrium with the presented images unstable, which may make continuous visualization of MS challenging in some cases (Figure S5). Although some cases showing the feasibility of ICE were recently reported from Japan, 20 no comparative study is available on the impact of ICE-guided TAVI on the reduction of subsequent conduction disturbances. Our study demonstrated that the combination of cusp-overlap technique and transjugular ICE provided a predictable THV bottom landing in the MS and an extremely low PPI rate (0.9%) without increasing adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Ishizu,

Shirai,

Miyawaki

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: A high permanent pacemaker implantation (PPI) risk remains a concern of self-expandable transcatheter aortic valve implantation, despite the continued improvements in implantation methodology. We aimed to assess the impact of real-time direct visualization of the membranous septum using transjugular intracardiac echocardiography (ICE) during transcatheter aortic valve implantation on reducing the rates of conduction disturbances including the need for PPI. METHODS: Consecutive patients treated with Evolut R and Evolut PRO/PRO+ from February 2017 to September 2022 were included in this study. We compared outcomes between the conventional implantation method using the 3-cusps view (3 cusps without ICE group), the recent method using cusp-overlap view (cusp overlap without ICE group), and our novel method using ICE (cusp overlap with ICE group). RESULTS: Of the 446 patients eligible for analysis, 211 (47.3%) were categorized as the 3 cusps without ICE group, 129 (28.9%) were in the cusp overlap without ICE group, and 106 (23.8%) comprised the cusp overlap with ICE group. Compared with the 3 cusps without ICE group, the cusp overlap without ICE group had a smaller implantation depth (2.2 [interquartile range, 1.0–3.5] mm versus 4.3 [interquartile range, 3.3–5.4] mm; P <0.001) and lower 30-day PPI rates (7.0% versus 14.2%; P =0.035). Compared with the cusp overlap without ICE group, the cusp overlap with ICE group had lower 30-day PPI rates (0.9%; P =0.014), albeit with comparable implantation depths (1.9 [interquartile range, 0.9–2.9] mm; P =0.150). Multivariable analysis showed that our novel method using ICE with the cusp-overlap view was independently associated with a 30-day PPI rate reduction. There were no group differences in 30-day all-cause mortality (1.4% versus 1.6% versus 0%; P =0.608). CONCLUSIONS: Our novel implantation method using transjugular ICE, which enable real-time direct visualization of the membranous septum, achieved a predictably high position of prostheses, resulting in a substantial reduction of conduction disturbances requiring PPI after transcatheter aortic valve implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Ishizu,

Shirai,

Miyawaki

et al. 2024

Circ: Cardiovascular Interventions

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“…ICE enables real-time direct visualization of the MS during THV implantation, and thus the operator can adjust the landing point at the MS with a repositionable THV. 21 Although some cases showing the feasibility of ICE were recently reported from Japan, 21 no comparative study is available on the impact of ICE-guided TAVI is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

Section: Discussionmentioning

confidence: 99%

“…ICE enables real-time direct visualization of the MS during THV implantation, and thus the operator can adjust the landing point at the MS with a repositionable THV. 21 Although some cases showing the feasibility of ICE were recently reported from Japan, 21 no comparative study is available on the impact of ICE-guided TAVI on the reduction of subsequent conduction disturbances. Our study demonstrated that the combination of cusp-overlap technique and transjugular ICE provided a predictable THV bottom landing in the MS and an extremely low PPI rate (0.9%) without increasing adverse outcomes, such as THV dislodgement and paravalvular leakage.…”

Section: Discussionmentioning

confidence: 99%

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Ishizu¹,

Shirai²,

Miyawaki³

et al. 2023

Preprint

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Background: A high permanent pacemaker implantation (PPI) risk remain a concern of self-expandable transcatheter aortic valve implantation (TAVI), despite continued improvements in implantation methodology. We aimed to assess the impact of real-time direct visualization of the membranous septum using transjugular intracardiac echocardiography (ICE) during TAVI on reducing the rates of conduction disturbances including the need for PPI. Methods: Consecutive patients treated with Evolut R and Evolut PRO/PRO+ from February 2017 to September 2022 were included in this study. We compared outcomes between the conventional implantation method using the 3-cusps view ("3-cusps without ICE" group), the recent method using cusp-overlap view ("cusp-overlap without ICE" group), and our novel method using ICE ("cusp-overlap with ICE" group). Results: Of the 446 patients eligible for analysis, 211 (47.3%) were categorized as the "3-cusps without ICE" group, 129 (28.9%) were in the "cusp-overlap without ICE" group, and 106 (23.8%) comprised the "cusp-overlap with ICE" group. Compared with the "3-cusps without ICE" group, the "cusp-overlap without ICE" group had a smaller implantation depth (2.2 [IQR 1.0-3.5] mm vs 4.3 [IQR: 3.3-5.4], P <0.001) and lower 30-day PPI rates (7.0% vs 14.2%, P = 0.035). Compared with the "cusp-overlap without ICE" group, the "cusp-overlap with ICE" group had lower 30-day PPI rates (1.0%, P = 0.014), albeit with comparable implantation depths (1.9 [IQR 0.9-2.9] mm, P = 0.150). Multivariable analysis showed that our novel method using ICE with the cusp-overlap view was independently associated with a 30-day PPI rate reduction. There were no group differences in 30-day all-cause mortality (1.4% vs 1.6% vs 0%; P = 0.254). Conclusions: Our novel implantation method using transjugular ICE, which enabled a real-time direct visualization of the membranous septum, achieved a predictably high position of prostheses, resulting in a substantial reduction of conduction disturbances requiring PPI after TAVI.

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“…Several studies have demonstrated that membranous septum length and valve depth in relation to this length are highly predictive of PPI. 8 , 23 Whether membranous septum-guided TAVR reduces the incidence of late-onset AVB requires further investigation. In a recent report by Krishnaswamy and colleagues, 24 patients receiving self-expanding valves required PPI more frequently than those receiving balloon-expandable valves within 30 days.…”

Section: Discussionmentioning

confidence: 99%

Late-onset atrioventricular block after transcatheter aortic valve replacement

et al. 2021

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Background Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain. Objectives We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR. Methods This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR. Results Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97–9.05, log-rank P = .09). Conclusion Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.

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Novel Strategy for Patients With Pre-Existing Right Bundle Branch Block

Cited by 6 publications

References 3 publications

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Late-onset atrioventricular block after transcatheter aortic valve replacement

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