Predictors of ventricular pacing burden after permanent pacemaker implantation following transcatheter aortic valve replacement

Elzeneini, Mohammed; Assaf, Yazan; Aalaei‐Andabili, Seyed Hossein; Mahmoud, Ahmad; Hamburger, Robert; Goel, Ramil; Bavry, Anthony A.

doi:10.1002/clc.23447

Cited by 7 publications

(8 citation statements)

References 22 publications

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“… 54 Other factors were found to predict a high percentage of long-term pacing in patients who experienced post-TAVI PPI such as high left ventricular outflow tract diameter ratio, high aortic annulus diameter ratio, new onset of left bundle branch block, time to PPI >2 days, and therapy with beta-blockers. 55 Consequently, the choice of intervention modality in patients with AS should take into account the factors mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

et al. 2022

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Aims The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). Methods and results A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10–1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13–1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12–1.40), although there was a similar tendency of the results in those at medium and low risk. Conclusion Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.

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Section: Discussionmentioning

confidence: 99%

Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

et al. 2022

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“…In those studies, recovery of AV node conduction was found in 50–73% of patients [ 13 , 20 ], thus superior to the rate observed in our population. Most studies defined PM non-dependency as VP < 5%, as we straightforwardly did [ 21 ]. It is worth mentioning that the percentage of VP may generally be influenced by different factors, including increased overnight pacing and “out of the box”, standardized algorithms which threaten tailored ones.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

Pinnacchio

Ruscio

Rocco

et al. 2022

JCDD

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Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4–6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.

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“…Some of the above factors have been proven to be predictors of new conduction block after TAVR, with the prosthesis implantation depth the most relevant risk factor. Other risk factors including the type of valve implanted, overexpansion of native annulus, the occurrence of right bundle branch block (RBBB) at baseline, preexisting LVOT calcification, preexisting first-degree AVB and prolonged baseline QRS duration, previous coronary bypass and female gender [15][16][17]. The presence of RBBB at baseline was one of the important predictors.…”

Section: Pathogenesis Predictive Factors Of New Onset Lbbbmentioning

confidence: 99%

Current Opinions on New-Onset Left Bundle Branch Block after Transcatheter Aortic Valve Replacement and the Search for Physiological Pacing

Zhang¹,

Pan²,

Wang³

et al. 2022

Rev. Cardiovasc. Med.

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Transcatheter aortic valve replacement possesses a high validity for patients with aortic stenosis who are considered high risk for aortic valve replacement surgery, nowadays it is also considered for patients with intermediate risk or even lower risk in certain situations. The incidence of new conduction abnormalities remains to be a tough problem, in particular, left bundle branch block. New-onset left bundle branch block is a major concern despite improvements in valve technology, and it may affect postoperative prognosis. Understanding the anatomical relationship between the conduction system and the aortic root, clarify factors related to the procedure, devices, and patients, might help to reduce the conduction abnormalities. Physiological pacing has emerged as a reasonable pacing strategy for patients with cardiac insufficiency post-valve replacement, especially combined with left bundle branch block. The purpose of this review is to summarize the current opinion on the incidence of new-onset left bundle branch block associated with transcatheter aortic valve replacement, to offer insights into its anatomical and procedural causes, clinical consequences, and more importantly, the prospect of applying physiological pacing as a therapeutic method for these patients.

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Predictors of ventricular pacing burden after permanent pacemaker implantation following transcatheter aortic valve replacement

Cited by 7 publications

References 22 publications

Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

Current Opinions on New-Onset Left Bundle Branch Block after Transcatheter Aortic Valve Replacement and the Search for Physiological Pacing

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