October 4, 2012Open Access

Predictive factors for pacemaker requirement after transcatheter aortic valve implantation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Symptomatic aortic valve stenosis (n=45). Intervention: Transcatheter aortic valve implantation (TAVI) vs. Patients not requiring a pacemaker. Primary outcome: High-grade AV block (type II second-degree and third-degree) requiring pacemaker (OR 24.85, 95% CI 1.57-392.57, p=0.023).

İAİbrahim AkınInterventional Cardiology SKStephan KischeInterventional Cardiology LPLylia ParanskayaUniversity of Rostock

Key Result

New left bundle branch block immediately after transcatheter aortic valve implantation strongly predicted the development of high-grade AV block requiring a permanent pacemaker (OR 24.85).

Study Design

Type

Observational (n=45)

Multicenter

Structured PICO

Does surface and intracardiac ECG evaluation immediately after TAVI predict the need for a pacemaker in patients with symptomatic aortic valve stenosis?

Population

45 inoperable patients with symptomatic aortic valve stenosis treated with transcatheter aortic valve implantation (TAVI)

Intervention

Evaluation of surface and intracardiac ECG parameters immediately (within 60 minutes) after TAVI

Comparator

Patients requiring a pacemaker (n=23) versus control group not requiring a pacemaker (n=22)

Outcome

Need for pacemaker (high-grade AV block, type II second-degree and third-degree)safety

Surface ECG evaluation immediately after TAVI can predict the need for permanent pacing, specifically identifying new LBBB, QRS >120 msec, and PQ >200 msec as key risk factors.

Main Result

Effect estimate: OR 24.85 (95% CI 1.57-392.57)

p-value: p=0.023

Limitations

Retrospective analysis design
Low number of patients (small sample size) may influence the results

Abstract

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI. METHODS: Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done. RESULTS: TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay. CONCLUSION: Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.

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Cite This Study

Akın et al. (Thu,) conducted a observational in Symptomatic aortic valve stenosis (n=45). Transcatheter aortic valve implantation (TAVI) vs. Patients not requiring a pacemaker was evaluated on High-grade AV block (type II second-degree and third-degree) requiring pacemaker (OR 24.85, 95% CI 1.57-392.57, p=0.023). New left bundle branch block immediately after transcatheter aortic valve implantation strongly predicted the development of high-grade AV block requiring a permanent pacemaker (OR 24.85).

synapsesocial.com/papers/6a1c233227b545b111a983d4 https://doi.org/https://doi.org/10.1186/1471-2261-12-87

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