Key result
In patients undergoing transcatheter aortic valve implantation, 30.2% required a permanent pacemaker, with baseline 1st degree AV block strongly predicting this need (OR 13, P=0.008).
Why the study?
Atrioventricular conduction disturbances requiring permanent pacemaker implantation are a common and clinically important complication following TAVI.
What is the incidence of conduction disorders and predictors for permanent pacemaker implantation after TAVI in patients with severe symptomatic aortic stenosis?
Cohort (n=53)
No
What is the incidence of conduction disorders and predictors for permanent pacemaker implantation after TAVI in patients with severe symptomatic aortic stenosis?
Odds Ratio: 13
p-value: p=0.008
Following TAVI, nearly one-third of patients required permanent pacemaker implantation during the index hospitalization, with baseline 1st degree AV block strongly predicting this need.
High post-TAVI conduction disorder rates may increase pacemaker needs; leaves open prosthesis-specific mitigation in prospective cohorts.
Background: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non-operable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM.
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Santos et al. (2019) conducted a cohort in Severe symptomatic aortic stenosis (n=53). 1st degree AV block vs. Absence of 1st degree AV block was evaluated on Permanent pacemaker (PPM) implantation (OR 13, p=0.008). In patients undergoing transcatheter aortic valve implantation, 30.2% required a permanent pacemaker, with baseline 1st degree AV block strongly predicting this need (OR 13, P=0.008).
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