Validation of the 2019 Expert Consensus Algorithm for the Management of Conduction Disturbances After TAVR

Malebranche, Daniel; Bartkowiak, Joanna; Ryffel, Christoph; Bernhard, Benedikt; Elsmaan, Mamdouh; Nozica, Nikolas; Okuno, Taishi; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Räber, Lorenz; Heg, Dik; Roten, Laurent; Windecker, Stephan; Pilgrim, Thomas; Reichlin, Tobias

doi:10.1016/j.jcin.2021.03.010

Cited by 15 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conduction disturbances occur commonly after TAVR, and an expert consensus algorithm was provided for managing post-TAVR conduction disturbances, but the optimal management of this complication is still unknown ( 68 , 69 ). Schoechlin et al ( 18 ) compared patients’ outcomes between different PPI implantation indications and revealed that the restrictive PPI strategy they adopted reduces the PPI rate significantly and is safe after a follow-up of 3 years.…”

Section: Discussionmentioning

confidence: 99%

Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Zhang

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

AimsTo date, the prognostic effects of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) remain controversial. The purpose of this meta-analysis was to investigate the mid- (1 year) to long-term (> 1 year) clinical and echocardiographic effects of post-procedural PPI in patients after TAVR.MethodsPubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the establishment of databases up to 1 December 2021. Studies comparing clinical and echocardiographic outcomes between patients with and without post-TAVR PPI of ≥ 1-year follow-up were collected for further meta-analysis.ResultsA total of 39 studies comprising of 83,082 patients were included in this meta-analysis. At mid-term follow-up (1 year), the pooled results demonstrated a higher risk of all-cause mortality in patients with post-procedural PPI than those without following TAVR (relative risk (RR), 1.17; 95% CI, 1.10–1.24; P < 0.00001). No significant differences were observed in cardiovascular mortality (RR, 0.86; 95% CI, 0.71–1.03; P = 0.10) or heart failure rehospitalization (RR, 0.91; 95% CI, 0.58–1.44; P = 0.69) at 1-year follow-up. At long-term follow-up (> 1 year), post-TAVR PPI had negative effects on all-cause mortality (RR, 1.18; 95% CI, 1.09–1.28; P < 0.0001) and heart failure rehospitalization (RR, 1.42; 95% CI, 1.18–1.71; P = 0.0002). There was no difference in long-term cardiovascular mortality between the two groups (RR, 1.15; 95% CI, 0.97–1.36; P = 0.11). Left ventricular ejection fraction (LVEF) was not significantly different at baseline (mean difference, 1.40; 95% CI, –0.13–2.93; P = 0.07), but was significantly lower in the PPI group at 1-year follow-up (mean difference, –3.57; 95% CI, –4.88 to –2.26; P < 0.00001).ConclusionOur meta-analysis provides evidence that post-TAVR PPI has negative clinical and echocardiographic effects on patients at mid- to long-term follow-up. Further studies are urgently needed to explore the cause of these complications and optimize the treatment and management of patients requiring permanent pacing after TAVR.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289935], identifier [CRD42021289935].

show abstract

Section: Discussionmentioning

confidence: 99%

Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Zhang

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Clinical validation of this expert consensus algorithm 50 shows that the majority of patients could be eligible for early discharge; however, a significant proportion of those categorized at higher risk required PPI, highlighting a need for more precise risk stratification.…”

Section: Discussionmentioning

confidence: 99%

“…The management of conduction disturbances following TAVR remains a clinical challenge. The European Heart Rhythm Association survey 48 Clinical validation of this expert consensus algorithm 50 shows that the majority of patients could be eligible for early discharge; however, a significant proportion of those categorized at higher risk required PPI, highlighting a need for more precise risk stratification.…”

Section: Recommendations For Managementmentioning

confidence: 99%

Post‐TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

Ghazal,

Garabedian,

Sawaya

et al. 2024

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta‐analyses identified preexisting right bundle branch block (RBBB), LAHB, and new‐onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self‐expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post‐TAVR, highlighting the need for further research and standardized treatment strategies.

show abstract

“…Univariate logistic regression was performed for each predictor and those with significant p values were selected as candidate predictors. A systematic review of risk factors for post-procedural PPMI in TAVR patients [ 11 , 17 , 18 , 24 ] were also used to select candidate predictors. Expert opinions were adopted when necessary to confirm relevant predictors or include predictors with large p values but potentially clinical significance.…”

Section: Methodsmentioning

confidence: 99%

A prediction model for permanent pacemaker implantation after transcatheter aortic valve replacement

Qi,

Lin,

Pan

et al. 2023

Eur J Med Res

View full text Add to dashboard Cite

Background This study aims to develop a post-procedural risk prediction model for permanent pacemaker implantation (PPMI) in patients treated with transcatheter aortic valve replacement (TAVR). Methods 336 patients undergoing TAVR at a single institution were included for model derivation. For primary analysis, multivariate logistic regression model was used to evaluate predictors and a risk score system was devised based on the prediction model. For secondary analysis, a Cox proportion hazard model was performed to assess characteristics associated with the time from TAVR to PPMI. The model was validated internally via bootstrap and externally using an independent cohort. Results 48 (14.3%) patients in the derivation set had PPMI after TAVR. Prior right bundle branch block (RBBB, OR: 10.46; p < 0.001), pre-procedural aortic valve area (AVA, OR: 1.41; p = 0.004) and post- to pre-procedural AVA ratio (OR: 1.72; p = 0.043) were identified as independent predictors for PPMI. AUC was 0.7 and 0.71 in the derivation and external validation set. Prior RBBB (HR: 5.07; p < 0.001), pre-procedural AVA (HR: 1.33; p = 0.001), post-procedural AVA to prosthetic nominal area ratio (HR: 0.02; p = 0.039) and post- to pre-procedural troponin-T difference (HR: 1.72; p = 0.017) are independently associated with time to PPMI. Conclusions The post-procedural prediction model achieved high discriminative power and accuracy for PPMI. The risk score system was constructed and validated, providing an accessible tool in clinical setting regarding the Chinese population.

show abstract

Validation of the 2019 Expert Consensus Algorithm for the Management of Conduction Disturbances After TAVR

Cited by 15 publications

References 18 publications

Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Post‐TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

A prediction model for permanent pacemaker implantation after transcatheter aortic valve replacement

Contact Info

Product

Resources

About