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Journal of Interventional Cardiac Electrophysiology

Erschienen in:

12.03.2018

Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement

verfasst von: Derek Leong, Ali A. Sovari, Ashkan Ehdaie, Tarun Chakravarty, Qiang Liu, Hasan Jilaihawi, Rajendra Makkar, Xunzhang Wang, Eugenio Cingolani, Michael Shehata

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

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Abstract

Background

Damage to the cardiac conduction system requiring permanent pacemaker (PPM) implantation is a known adverse outcome of transcatheter aortic valve replacement (TAVR). A permanent-temporary pacemaker (PTPM) is a device that involves an active-fixation lead attached to an external pulse generator taped to the skin. We reviewed the utility of PTPMs as a temporary bridge measure after TAVR in patients with conduction abnormalities that do not meet conventional criteria for PPM placement.

Methods

Between January 01, 2013 and December 31, 2015, we analyzed 67 patients who received PTPM after TAVR. Baseline demographics, comorbidities, type and size of the valve, pre-TAVR electrocardiograms (ECGs), post-TAVR ECGs at 1 day, 1 month, and 6 months, and pacemaker interrogation results were reviewed for each patient if available.

Results

The mean age of patients was 80.5 ± 9.1 years. PTPM were placed for 2.3 ± 2.4 days. Among these patients, 44.8% (n = 30) received a PPM prior to discharge. Male gender (OR 2.84, 95% CI 1.05–7.69, p = 0.05) and an increase in QRS duration post-TAVR (p = 0.01) were associated with PPM placement. Pacemaker interrogation data of 11 patients with PPM revealed that 27% (n = 3) had < 1% V-pacing requirements and < 10% A-pacing requirements.

Conclusions

In post-TAVR patients who develop conduction abnormalities that do not meet conventional PPM implantation indications, PTPM safely provides a time period for further assessment and may prevent unnecessary PPM implantation. Male gender and an increase in QRS duration post-TAVR are associated with PPM implantation. Additionally, some patients may recover from their conduction disturbances and demonstrate low pacemaker utilization.

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Titel: Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement
verfasst von: Derek Leong
Ali A. Sovari
Ashkan Ehdaie
Tarun Chakravarty
Qiang Liu
Hasan Jilaihawi
Rajendra Makkar
Xunzhang Wang
Eugenio Cingolani
Michael Shehata
Publikationsdatum: 12.03.2018
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/s10840-018-0345-z

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Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement