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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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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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Springer Medizin

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

Abstract

Purpose

Methods

Results

Conclusions

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Update Kardiologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

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