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Journal of Interventional Cardiac Electrophysiology

Erschienen in:

19.12.2017 | MULTIMEDIA REPORT

Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients

verfasst von: Esseim Sharma, Antony F. Chu

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 1/2018

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Abstract

Purpose

Transcatheter aortic valve replacement (TAVR) is an increasingly prevalent therapy in patients with severe symptomatic aortic stenosis. Conduction disturbances requiring permanent pacemaker (PPM) implantation are a known complication of TAVR. This study investigated the progression of cardiac conduction disease in the post-TAVR pacemaker population and identified predictors of post-TAVR right ventricular (RV) pacing dependence.

Methods

Prospectively collected echocardiographic, ECG, and PPM interrogation data of 262 consecutive patients who underwent TAVR with placement of a balloon-expandable valve at one institution from March 2012 to October 2016 were analyzed.

Results

A total of 25 patients (11.1%) required post-TAVR PPM implantation. Seventeen patients who received PPMs did not require RV pacing at 30 days. Nine of these 17 patients had no RV pacing requirement within 10 days. Pre-existing right bundle branch block (RBBB) (OR 105.4, 4.52–2458.5, p = 0.0002), bifascicular block (OR 12.50, 1.60–97.65, p = 0.02), intra-procedural complete heart block (OR 12.83, 1.26–130.52, p = 0.03), and QRS duration > 120 ms (OR 70.43, 3.23–1535.22, p = 0.0002) on pre-TAVR ECG were associated with RV pacing dependence at 30 days.

Conclusions

Sixty-eight percent of patients meeting post-procedural guideline indications for PPM did not require RV pacing at 30 days. Fifty-two percent of these patients demonstrated recovery of sinus node function or AV conduction within 10 days post-implant. RBBB, intra-procedural complete heart block, bifascicular block, and QRS duration > 120 ms were associated with RV pacing dependence at 30 days. These findings suggest that post-TAVR conduction disturbances may be acutely reversible in a significant proportion of patients receiving PPM within 10–30 days of implant.

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Khatri PJ, Webb JG, Rodés-Cabau J, Fremes SE, Ruel M, Lau K, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158(1):35–46. https://doi.org/10.7326/0003-4819-158-1-201301010-00007.CrossRefPubMed

Jilaihawi H, Chakravarty T, Weiss RE, Fontana GP, Forrester J, Makkar RR. Meta-analysis of complications in aortic valve replacement: comparison of Medtronic-Corevalve, Edwards-Sapien and surgical aortic valve replacement in 8,536 patients. Catheter Cardiovasc Interv. 2012;80(1):128–38. https://doi.org/10.1002/ccd.23368.CrossRefPubMed

Erkapic D, et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: a comprehensive analysis of the literature. J Cardiovasc Electrophysiol. 2012;23(4):391–7. https://doi.org/10.1111/j.1540-8167.2011.02211.x.CrossRefPubMed

Nazif TM, Dizon JM, Hahn RT, Xu K, Babaliaros V, Douglas PS, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):60–9. https://doi.org/10.1016/j.jcin.2014.07.022.CrossRefPubMed

Kawashima T, Sato F. Visualizing anatomical evidences on atrioventricular conduction system for TAVI. Int J Cardiol. 2014;174(1):1–6. https://doi.org/10.1016/j.ijcard.2014.04.003.CrossRefPubMed

Young Lee M, Chilakamarri Yeshwant S, Chava S, Lawrence Lustgarten D. Mechanisms of heart block after transcatheter aortic valve replacement – cardiac anatomy, clinical predictors and mechanical factors that contribute to permanent pacemaker implantation. Arrhythm Electrophysiol Rev. 2015;4(2):81–5. https://doi.org/10.15420/aer.2015.04.02.81.CrossRefPubMedPubMedCentral

Maan A, et al. Incidence and predictors of pacemaker implantation in patients undergoing transcatheter aortic valve replacement. Pacing Clin Electrophysiol. 2015;38(7):878–86. https://doi.org/10.1111/pace.12653.CrossRefPubMed

Fadahunsi OO, Olowoyeye A, Ukaigwe A, Li Z, Vora AN, Vemulapalli S, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv. 2016;9(21):2189–99. https://doi.org/10.1016/j.jcin.2016.07.026.CrossRefPubMed

Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, O'Regan DJ, et al. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2013;17(2):328–33. https://doi.org/10.1093/icvts/ivt175.CrossRefPubMedPubMedCentral

10.

van der Boon RM, et al. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System. Int J Cardiol. 2013;168(2):1269–73. https://doi.org/10.1016/j.ijcard.2012.11.115.CrossRefPubMed

11.

Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, et al. Short-term pacemaker dependency after transcatheter aortic valve implantation. Wien Klin Wochenschr. 2016;128(5–6):198–203. https://doi.org/10.1007/s00508-015-0906-4.CrossRefPubMed

12.

Nagatomo T, et al. New onset of pacemaker dependency after permanent pacemaker implantation. Pacing Clin Electrophysiol. 2004;27(4):475–9. https://doi.org/10.1111/j.1540-8159.2004.00466.x.CrossRefPubMed

13.

Bagur R, Rodés-Cabau J, Gurvitch R, Dumont É, Velianou JL, Manazzoni J, et al. Need for permanent pacemaker as a complication of transcatheter aortic valve implantation and surgical aortic valve replacement in elderly patients with severe aortic stenosis and similar baseline electrocardiographic findings. JACC Cardiovasc Interv. 2012;5(5):540–51. https://doi.org/10.1016/j.jcin.2012.03.004.CrossRefPubMed

14.

Siontis GC, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol. 2014;64(2):129–40. https://doi.org/10.1016/j.jacc.2014.04.033.CrossRefPubMed

15.

Laynez A, Ben-Dor I, Barbash IM, Hauville C, Sardi G, Maluenda G, et al. Frequency of conduction disturbances after Edwards SAPIEN percutaneous valve implantation. Am J Cardiol. 2012;110(8):1164–8. https://doi.org/10.1016/j.amjcard.2012.05.057.CrossRefPubMed

16.

Nazif TM, Williams MR, Hahn RT, Kapadia S, Babaliaros V, Rodés-Cabau J, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J. 2014;35(24):1599–607. https://doi.org/10.1093/eurheartj/eht376.CrossRefPubMed

17.

Godin M, Eltchaninoff H, Furuta A, Tron C, Anselme F, Bejar K, et al. Frequency of conduction disturbances after transcatheter implantation of an Edwards Sapien aortic valve prosthesis. Am J Cardiol. 2010;106(5):707–12. https://doi.org/10.1016/j.amjcard.2010.04.029.CrossRefPubMed

18.

Sinhal A, Altwegg L, Pasupati S, Humphries KH, Allard M, Martin P, et al. Atrioventricular block after transcatheter balloon expandable aortic valve implantation. JACC Cardiovasc Interv. 2008;1(3):305–9. https://doi.org/10.1016/j.jcin.2007.12.009.CrossRefPubMed

19.

Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1(1):74–81. https://doi.org/10.1161/CIRCINTERVENTIONS.108.780858.CrossRefPubMed

20.

Moreno R, Dobarro D, Lopez de Sa E, Prieto M, Morales C, Calvo Orbe L, et al. Cause of complete atrioventricular block after percutaneous aortic valve implantation: insights from a necropsy study. Circulation. 2009;120(5):e29–30. https://doi.org/10.1161/CIRCULATIONAHA.109.849281.CrossRefPubMed

21.

Urena M, Mok M, Serra V, Dumont E, Nombela-Franco L, DeLarochellière R, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol. 2012;60(18):1743–52. https://doi.org/10.1016/j.jacc.2012.07.035.CrossRefPubMed

22.

Husser O, Pellegrini C, Kessler T, Burgdorf C, Thaller H, Mayr NP, et al. Predictors of permanent pacemaker implantations and new-onset conduction abnormalities with the SAPIEN 3 balloon-expandable transcatheter heart valve. JACC Cardiovasc Interv. 2016;9(3):244–54. https://doi.org/10.1016/j.jcin.2015.09.036.CrossRefPubMed

23.

Dvir D, Webb JG, Piazza N, Blanke P, Barbanti M, Bleiziffer S, et al. Multicenter evaluation of transcatheter aortic valve replacement using either SAPIEN XT or CoreValve: degree of device oversizing by computed-tomography and clinical outcomes. Catheter Cardiovasc Interv. 2015;86(3):508–15. https://doi.org/10.1002/ccd.25823.CrossRefPubMed

24.

Yang TH, Webb JG, Blanke P, Dvir D, Hansson NC, Nørgaard BL, et al. Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the Sapien 3: a comparison with the Sapien XT. JACC Cardiovasc Interv. 2015;8(3):462–71. https://doi.org/10.1016/j.jcin.2014.10.014.CrossRefPubMed

25.

Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51(21):e1–62. https://doi.org/10.1016/j.jacc.2008.02.032.CrossRefPubMed

26.

Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002;346(24):1854–62. https://doi.org/10.1056/NEJMoa013040.CrossRefPubMed

27.

Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107(23):2932–7. https://doi.org/10.1161/01.CIR.0000072769.17295.B1.CrossRefPubMed

28.

Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol. 2009;54(9):764–76. https://doi.org/10.1016/j.jacc.2009.06.006.CrossRefPubMed

29.

De Sisti A, et al. Adverse effects of long-term right ventricular apical pacing and identification of patients at risk of atrial fibrillation and heart failure. Pacing Clin Electrophysiol. 2012;35(8):1035–43. https://doi.org/10.1111/j.1540-8159.2012.03371.x.CrossRefPubMed

30.

Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288(24):3115–23.CrossRefPubMed

31.

Urena M, Webb JG, Tamburino C, Munoz-Garcia AJ, Cheema A, Dager AE, et al. Permanent pacemaker implantation after transcatheter aortic valve implantation: impact on late clinical outcomes and left ventricular function. Circulation. 2014;129(11):1233–43. https://doi.org/10.1161/CIRCULATIONAHA.113.005479.CrossRefPubMed

32.

De Carlo M, Giannini C, Bedogni F, Klugmann S, Brambilla N, de Marco F, et al. Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation. Am Heart J. 2012;163(3):492–9. https://doi.org/10.1016/j.ahj.2011.12.009.CrossRefPubMed

33.

Binder RK, Webb JG, Toggweiler S, Freeman M, Barbanti M, Willson AB, et al. Impact of post-implant SAPIEN XT geometry and position on conduction disturbances, hemodynamic performance, and paravalvular regurgitation. JACC Cardiovasc Interv. 2013;6(5):462–8. https://doi.org/10.1016/j.jcin.2012.12.128.CrossRefPubMed

34.

Mauri V, Reimann A, Stern D, Scherner M, Kuhn E, Rudolph V, et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement with the SAPIEN 3. JACC Cardiovasc Interv. 2016;9(21):2200–9. https://doi.org/10.1016/j.jcin.2016.08.034.CrossRefPubMed

35.

Tarantini G, Mojoli M, Purita P, Napodano M, D’Onofrio A, Frigo A, et al. Unravelling the (arte)fact of increased pacemaker rate with the Edwards SAPIEN 3 valve. EuroIntervention. 2015;11(3):343–50. https://doi.org/10.4244/EIJY14M11_06.CrossRefPubMed

Titel: Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients
verfasst von: Esseim Sharma
Antony F. Chu
Publikationsdatum: 19.12.2017
Verlag: Springer US
Erschienen in: Journal of Interventional Cardiac Electrophysiology / Ausgabe 1/2018
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0303-1

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Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients

Abstract

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