Utility of Invasive Electrophysiology Studies in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Rogers, Toby; Devraj, Mithun; Thomaides, Athanasios; Steinvil, Arie; Lipinski, Michael J.; Buchanan, Kyle; Alraies, M. Chadi; Koifman, Edward; Gai, Junyi; Torguson, Rebecca; Okubagzi, Petros; Ben‐Dor, Itsik; Pichard, Augusto D.; Satler, Lowell F.; Waksman, Ron

doi:10.1016/j.amjcard.2018.02.015

Cited by 40 publications

(26 citation statements)

References 22 publications

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“…Figure 1 shows the PRISMA flow diagram, and Table 1 shows the baseline characteristics of included studies. 8,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”

Section: Resultsmentioning

confidence: 99%

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: A systematic review and meta-analysis

Liu

Liang

et al. 2019

Preprint

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Background: The incidence of conduction disturbances requiring permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have remained a common concern. The purpose of this study was to evaluate the impact of postprocedural PPM implantation following TAVR on clinical outcomes. Methods: We performed a systematic search in PubMed and EMBASE databases for studies that reported raw data on clinical outcomes of patients with and without PPM implantation after TAVR and followed up patients for 10 months or longer. The primary endpoint was all-cause death. The secondary endpoints were cardiovascular death, heart failure and a composite of stroke and myocardial infarction (MI). Results: Data from 20 studies with a total of 21666 patients undergoing TAVR, of whom 12.5% required PPM implantation after intervention, were analysed and the mean duration follow-up was 16.9 months. The rate of PPM ranged from 6.2% to 32.8% among different studies. A total of 6753 (31.2%) patients underwent TAVR with self-expandable prosthesis and 14913 (68.8%) with balloon-expandable prosthesis. The incidence of postprocedural PPM implantation was higher with the self-expandable prosthesis (n=1717, 25.4%) compared with the balloon-expandable prosthesis (n=996, 6.7%). PPM after TAVR was associated with a higher risk of all-cause death (RR: 1.13; 95% CI: 1.01-1.25; P=0.03) but not incidence of stroke and MI (RR: 0.85; 95% CI: 0.64-1.13; P=0.27). Conclusions: In patients undergoing TAVR, the PPM implantation after intervention was associated higher all-cause mortality but not cardiovascular mortality, heart failure and stroke or MI, which remain an unsolved issue of TAVR.

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“…Figure 1 shows the PRISMA flow diagram, and Table 1 shows the baseline characteristics of included studies. 8,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”

Section: Resultsmentioning

confidence: 99%

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: A systematic review and meta-analysis

Liu

Liang

et al. 2019

Preprint

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“…In this largest study, they found that an EPS‐guided strategy in patients with equivocal indications for pacing avoided PPM implantation in over 70% of patients 35 . In their overall population (n = 614), 212 pts (34.5%) exhibited conduction disturbances from which 117/212 (55.2%) pts were implanted directly for HAVB and the other patients underwent EPSs (n = 95), of which 29.5% subsequently underwent PPM implantation (n = 28) and 70.5% did not (n = 67) 35 . The authors used an increased HV interval ≥100 ms with IV procainamide in order to increase the specificity of the test at the expense of sensitivity.…”

Section: Discussionmentioning

confidence: 97%

“…More recently, Rogers T. et al. published their new strategy in which post‐TAVR patients with equivocal indications for pacing underwent EPSs to determine the need for PPM implantation 35 . In this largest study, they found that an EPS‐guided strategy in patients with equivocal indications for pacing avoided PPM implantation in over 70% of patients 35 .…”

Section: Discussionmentioning

confidence: 99%

“…published their new strategy in which post‐TAVR patients with equivocal indications for pacing underwent EPSs to determine the need for PPM implantation 35 . In this largest study, they found that an EPS‐guided strategy in patients with equivocal indications for pacing avoided PPM implantation in over 70% of patients 35 . In their overall population (n = 614), 212 pts (34.5%) exhibited conduction disturbances from which 117/212 (55.2%) pts were implanted directly for HAVB and the other patients underwent EPSs (n = 95), of which 29.5% subsequently underwent PPM implantation (n = 28) and 70.5% did not (n = 67) 35 .…”

Section: Discussionmentioning

confidence: 99%

“…The authors used an increased HV interval ≥100 ms with IV procainamide in order to increase the specificity of the test at the expense of sensitivity. In other words, fewer patients got a pacemaker, but those who did likely needed it 35 . A clinical trial is currently underway to further study the safety and effectiveness of EPSs after TAVR and will hopefully provide more data on optimal PPM implantation thresholds 34 .…”

Section: Discussionmentioning

confidence: 99%

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Predictors of high‐degree conduction disturbances and pacemaker implantation after transcatheter aortic valve replacement: Prognostic role of the electrophysiological study

Ferreira

Costa

Cerisier

et al. 2021

Pacing Clinical Electrophis

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Background Predictors of high‐degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) are recognized, but the electrophysiological study's (EPS) role is still a subject to debate. The objective of our study was to determine factors associated with PPM implantation including the potential role of EPS before and/or after TAVR. Methods and results Seventy four consecutive patients (pts) were included and 21 pts (28.4%) received a PPM during the immediate postoperative follow‐ups (until Day 5): HAVB in 15 pts (71.4%), prophylactic implantation due to a documented increased HV interval ≥ 95–100 ms plus LBBB in 2 pts (9.5%), a high‐degree HV block evidenced at the EPS plus LBBB in 3 pts (14.3%) and one additional patient was implanted for AV‐block in presence of AFib (4.8%). In the multivariate model 1 including parameters before TAVR, both prosthesis diameter and PR lengthening remained significantly associated with PPM as well RBBB. In the multivariate model 2 including parameters after TAVR, only HV remained significantly associated with the risk of PPM (OR = 1.15 (1.05–1.26), p = .004). When all the significant variables in models 1 and 2 were analyzed together in model 3, only HV after TAVR remained significantly associated with an increased risk of PPM. Conclusions In this prospective observational study, it was revealed that a Day 4–5 EPS is likely to more precisely stratify the risk of PPM implantation regarding its ability to discover asymptomatic severe infra‐hisian conduction disturbances particularly in presence of LBBB. Multivariate analysis confirmed the prognostic value of HV alteration.

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Conduction Disturbances

Ben‐Dor

Waksman

2021

Aortic Valve Transcatheter Intervention

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Utility of Invasive Electrophysiology Studies in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Cited by 40 publications

References 22 publications

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: A systematic review and meta-analysis

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: A systematic review and meta-analysis

Predictors of high‐degree conduction disturbances and pacemaker implantation after transcatheter aortic valve replacement: Prognostic role of the electrophysiological study

Conduction Disturbances

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