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Domondon IAA, Jeyakumar D, Raake M, Halaharvi SP, Zafar F, Contreras Vazquez SA, Abarca YA, Goli SR, Rohra D, Shah F, Sikander M, Al-Tawil M. Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00321. [PMID: 39254505 DOI: 10.1097/crd.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41-0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38-0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: -3.35; 95% CI, -4.93 to -1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29-3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47-1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39-1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38-2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01-2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.
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Affiliation(s)
- Ileana Anika A Domondon
- From the Emergency Medicine Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Deepapriya Jeyakumar
- Internal Medicine Department, Government Sivagangai Medical College, Tamil Nadu Dr. M.G.R Medical University, Sivagangai, India
| | - Mohammed Raake
- Faculty of Medicine, Annamalai University, Chidambaram, Cuddalore, India
| | - Savitri Poornima Halaharvi
- Department of Cardiology, JSS Medical College, Rajiv Gandhi University of Health Sciences, Mysore, India
| | - Fabeha Zafar
- Department of Cardiology, Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Yozahandy A Abarca
- Department of Cardiology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Snehitha Reddy Goli
- Department of Cardiology, College of Medicine, Zhengzhou University, Henan Province, Henan, China
| | - Divya Rohra
- Department of Cardiology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Farah Shah
- Internal Medicine Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Mohammed Sikander
- Department of Cardiology, School of Medicine, University of Texas Rio Grande Valley, TX; and
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Merdler I, Case BC, Ben-Dor I, Chitturi KR, Fahey H, Hayat F, Isaac I, Satler LF, Rogers T, Waksman R. Impact of left bundle branch block or permanent pacemaker after transcatheter aortic valve replacement on mid-term left ventricular ejection fraction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00561-X. [PMID: 39209580 DOI: 10.1016/j.carrev.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Conduction disturbances have uncertain implications for long-term left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR). We aimed to examine LVEF changes in patients up to two years post-TAVR. METHODS We examined patients who underwent TAVR between 2012 and 2020 and underwent echocardiography follow-up. Patients were categorized into four groups: 1) Those without a permanent pacemaker (PPM) or left bundle branch block (LBBB) pre- or post-TAVR; 2) Patients with pre- and post-TAVR LBBB; 3) Individuals with preexisting PPM; and 4) Patients requiring new PPM after TAVR. LVEF was assessed at the outset of TAVR, at 30 days, 1-year, and 2-years post-TAVR. RESULTS The study included 730 patients: 421 (57.6 %) without conduction abnormalities, 151 (20.7 %) with post-TAVR LBBB (48 pre-existing, 103 new-onset), 63 (8.6 %) with pre-existing PPM, and 95 (13.1 %) requiring new PPM. At discharge, patients without conduction abnormalities exhibited the highest LVEF (57.4 ± 11.5 %), whereas those with pre-existing PPM had the lowest (48.1 ± 15.5 %). Over two years, LVEF remained constant in patients without conduction issues and in those with pre-existing PPM. However, patients with new LBBB experienced a 6.3 % decrease in LVEF, and those requiring new PPM showed a 4.1 % reduction. CONCLUSION New conduction abnormalities, such as LBBB or the need for PPM, induce a decline in LVEF post-TAVR. It is imperative to focus on the long-term monitoring of left ventricular function in patients experiencing new conduction disturbances post-TAVR.
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Affiliation(s)
- Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Heather Fahey
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Fatima Hayat
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Imad Isaac
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024; 13:e032777. [PMID: 38639357 PMCID: PMC11179913 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown. METHODS AND RESULTS In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12-lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new-onset bundle-branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new-onset BBB, new-onset left BBB, and new-onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new-onset BBB and those with new-onset left BBB, the rate of PPI was higher in patients with new-onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post-TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new-onset RBBB was a statistically significant predictor of PPI compared with no new-onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94-54.4]) in addition to the use of a self-expanding valve (OR, 2.97 [95% CI, 1.09-8.10]). CONCLUSIONS Patients with new-onset RBBB after TAVR are at high risk for PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yugo Minamimoto
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kensuke Matsushita
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Tomoki Cho
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kengo Terasaka
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Hidefumi Nakahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yuichiro Kimura
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Keiji Uchida
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
- Department of CardiologyYokohama City University Graduate School of MedicineYokohamaJapan
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Saito T, Inohara T, Tsuruta H, Yashima F, Shimizu H, Fukuda K, Ohno Y, Nishina H, Izumo M, Asami M, Naganuma T, Mizutani K, Yamawaki M, Tada N, Yamanaka F, Shirai S, Noguchi M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Pre-Existing Left Bundle Branch Block and Clinical Outcomes After Transcatheter Aortic Valve Replacement. JACC. ASIA 2024; 4:306-319. [PMID: 38660100 PMCID: PMC11035950 DOI: 10.1016/j.jacasi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 04/26/2024]
Abstract
Background Few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR) are currently available. Further, no present studies compare patients with new onset LBBB with those with pre-existing LBBB. Objectives This study aimed to investigate the association between pre-existing or new onset LBBB and clinical outcomes after TAVR. Methods Using data from the Japanese multicenter registry, 5,996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB, and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportional hazards models and propensity score analysis to adjust the differences in baseline characteristics. Results Of 5,996 patients who underwent TAVR, 280 (4.6%) had pre-existing LBBB, while 1,658 (27.6%) experienced new onset LBBB. Compared with the no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated not only with a higher 2-year all-cause (adjusted HR: 1.39; 95% CI: 1.06-1.82; P = 0.015) and cardiovascular (adjusted HR: 1.60; 95% CI: 1.04-2.48; P = 0.031) mortality, but also with higher all-cause (adjusted HR: 1.43, 95% CI: 1.07-1.91; P = 0.016) and cardiovascular (adjusted HR: 1.81, 95% CI:1.12-2.93; P = 0.014) mortality than the new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group. Conclusions Pre-existing LBBB was independently associated with poor clinical outcomes, reflecting an increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.
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Affiliation(s)
- Tetsuya Saito
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | | | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Tsurumi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - the OCEAN-TAVI Investigators
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
- Department of Cardiology, St. Marianna University, Tokyo, Japan
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
- Department of Cardiology, Kinki University, Osaka, Japan
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Tsurumi, Japan
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
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Tamargo M, Gutiérrez-Ibañes E. Left Bundle Branch Block in Aortic Stenosis: Implications Beyond Pacemaker Implantation. JACC. ASIA 2024; 4:320-322. [PMID: 38660102 PMCID: PMC11035939 DOI: 10.1016/j.jacasi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- María Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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Rao K, Chan B, Baer A, Hansen P, Bhindi R. A Systematic Review of Delayed High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation. CJC Open 2024; 6:86-95. [PMID: 38585677 PMCID: PMC10994975 DOI: 10.1016/j.cjco.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/03/2023] [Indexed: 04/09/2024] Open
Abstract
Background High-grade atrioventricular block (HGAVB) is common after transcatheter aortic valve implantation (TAVI), often necessitating permanent pacemaker (PPM) implantation. Delayed HGAVB has varying definitions but typically refers to onset 48 hours after TAVI or following discharge and may cause syncope and sudden cardiac death. This review estimates the incidence of delayed HGAVB and identifies limitations of current literature. Methods A systematic review was performed of the following online databases: Medline, Cochrane, Web of Science, and Scopus. Studies that labelled the outcome of "delayed" or "late" atrioventricular block after TAVI were included; patients with previous PPM or aortic valve surgery were excluded. Initial search yielded 775 studies, which, after screening, was narrowed to 19 studies. Results Nineteen studies with 14,898 patients were included. Mean age was 81.7 years, and 46.3% were male. Mean Society of Thoracic Surgeons (STS) score was 5.6%, and 31.3% of patients had known atrial fibrillation. The most common access site was transfemoral (84.8%), whereas balloon-expandable valves were used in 62.1%, self-expanding valves in 34.0%, and mechanically expanding valves in 3.9% of cases. The incidence of delayed HGAVB ranged from 1.7% to 14.6%, with significant methodologic heterogeneity noted among the included studies. Conclusions Delayed HGAVB is a common and potentially serious complication of TAVI, with similar risk factors to acute HGAVB. With a move toward an early discharge strategy post-TAVI, further prospective study of delayed HGAVB is warranted to improve understanding of predisposing factors, incidence, timing, and implications.
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Affiliation(s)
- Karan Rao
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Bernard Chan
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Alexandra Baer
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
| | - Peter Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, North Shore Private Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Chandrasekar B, AlMerri K, AlEnezi A, AlRashdan I, AlKhdair D, AlKandari F. Native aortic leaflets and permanent pacemaker implantation risk following balloon-expandable transcatheter aortic valve implantation. Indian Heart J 2023; 75:268-273. [PMID: 37406856 PMCID: PMC10421988 DOI: 10.1016/j.ihj.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Permanent pacemaker implantation (PPI) risk is higher following transcatheter aortic valve implantation (TAVI) than surgical valve replacement. Native aortic leaflets are retained in patients undergoing TAVI, unlike in surgical valve replacement. Whether the retained leaflets influence PPI risk because of their proximity to the conduction system is unknown. The study sought to determine the association between infra-annular extension of native right coronary cusp/noncoronary cusp (RCC/NCC) post balloon-expandable TAVI and PPI risk. METHODS We performed a retrospective analysis of 190 patients undergoing balloon-expandable TAVI at a single center. Manifestation of infra-annular extension of RCC/NCC was considered to be present when part of leaflet extended below aortic-annular plane on post-implantation aortic-root angiography. RESULTS Infra-annular extension of RCC/NCC was observed in 33 patients (17.37%). PPI incidence post-TAVI was higher in patients with infra-annular extension of RCC/NCC than in those without (36.36% versus 8.92%, relative-risk: 4.08, p˂0.0001). On logistic-regression analysis, preexisting right bundle-branch block (RBBB) (odds-ratio: 12.73, 95% confidence-interval: 2.16-74.93, p = 0.005), and infra-annular extension of RCC/NCC (odds-ratio: 5.63, 95% confidence-interval: 2.17-14.58, p < 0.0001) were independently associated with PPI risk. Preexisting RBBB (φ = +0.25, p = 0.001) and infra-annular extension of RCC/NCC (φ = +0.30, p < 0.0001) showed a positive-correlation with PPI risk. Infra-annular extension of RCC/NCC was a significant predictor of PPI risk on receiver-operating-characteristic curve analysis (area under-the-curve 0.67; 95% confidence-interval: 0.54-0.79, p = 0.006). CONCLUSION The retained native aortic leaflets play a significant role in PPI risk following balloon-expandable TAVI. Infra-annular extension of RCC/NCC is a novel predictor, and is associated with a four-fold higher risk of PPI.
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Affiliation(s)
| | - Khaled AlMerri
- Department of Cardiology, Chest Diseases Hospital, Kuwait
| | | | | | - Darar AlKhdair
- Department of Cardiology, Chest Diseases Hospital, Kuwait
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Yagel O, Belhassen B, Planer D, Amir O, Elbaz-Greener G. The R-wave amplitude in V1 on baseline electrocardiogram correlates with the occurrence of high-degree atrioventricular block following left bundle branch block after transcatheter aortic valve replacement. Europace 2023; 25:euad066. [PMID: 36938963 PMCID: PMC10227649 DOI: 10.1093/europace/euad066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/26/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Several procedural and electrocardiogram (ECG) parameters have been associated with the occurrence of high-degree atrioventricular block (AVB) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). We hereunder sought to assess if the baseline R-wave amplitude in V1 ECG lead of patients with normal QRS duration undergoing TAVR is associated with a higher patient's risk for developing high-degree AVB following left bundle branch block (LBBB). METHODS AND RESULTS In this retrospective single-centre study in 720 consecutive patients who underwent TAVR, 141 (19.6%) patients with normal QRS duration developed a new LBBB after TAVR. The 24 (17%) patients who underwent PPI for reasons other than high-degree AVB were excluded from further analysis. In the remaining 117 study patients, 14 (12%) developed high-degree AVB requiring PPI (Group 1) while the remaining 103 (88%) patients did not (Group 2). There were no significant differences in baseline demographic or procedural characteristics nor in PR interval, QRS duration, and QRS axis between these two groups. The incidence of left anterior hemiblock was higher in Group 1 (3 of 14, 21.4%) than that in Group 2 (9 of 103, 8.7%), but the difference was not statistically significant (P = 0.156). The R-wave amplitude in V1 was smaller in Group 1 than that in Group 2 (0.029 ± 0.04 mV vs. 0.11 ± 0.14 mV, P = 0.0316). In the receiver-operating characteristics analysis, the cutoff for R-wave amplitude pre-TAVR was 0.03 mV, area under the curve = 0.7219 (P = 0.0002). CONCLUSION The R-wave amplitude in lead V1 during baseline ECG in patients with normal QRS duration may predict the occurrence of high-degree AVB following new LBBB after TAVR.
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Affiliation(s)
- Oren Yagel
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Bernard Belhassen
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - David Planer
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Offer Amir
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Gabby Elbaz-Greener
- Hadassah Medical Center, Heart Institute, Kyriat Hadassah, PO Box 12000, 91120 Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem 91904, Israel
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Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2023; 112:677-690. [PMID: 36680617 PMCID: PMC10160192 DOI: 10.1007/s00392-023-02160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
AIM Transcatheter aortic valve replacement (TAVR) can cause intraventricular conduction disturbances (ICA), particularly left bundle branch block (BBB) and high-degree atrioventricular block (HAVB). The aim of this study was to investigate clinical, anatomical, procedural, and electrophysiological parameters predicting ICA after TAVR. METHODS Patients with severe aortic stenosis (n = 203) without pacing devices undergoing TAVR with a self-expanding (n = 103) or balloon-expanding (n = 100) valve were enrolled. Clinical and anatomical parameters, such as length of the membranous septum (MS) and implantation depth, were assessed. His-ventricular interval (HVi) before and after implantation was determined. 12-lead-electrocardiograms (ECG) before, during and after 3 and 30 days after TAVR were analyzed for detection of any ICA. RESULTS Among 203 consecutive patients (aortic valve area 0.78 ± 0.18 cm2, age 80 ± 6 years, 54% male, left ventricular ejection fraction 52 ± 10%), TAVR led to a significant prolongation of infranodal conduction in all patients from 49 ± 10 ms to 59 ± 16 ms (p = 0.01). The HVi prolongation was independent of valve types, occurrence of HAVB or ICA. Fifteen patients (7%) developed HAVB requiring permanent pacemaker (PPM) implantation and 63 patients (31%) developed ICA within 30 days. Pre-existing BBB (OR 11.64; 95% CI 2.87-47.20; p = 0.001), new-onset left BBB (OR 15.72; 95% CI 3.05-81.03; p = 0.001), and diabetes mellitus (OR 3.88; 95% CI 1.30-15.99; p = 0.02) independently predicted HAVB requiring PPM. Neither pre-existing right BBB, a prolonged postHVi, increases in PR duration, any of the TAVR implantation procedural and anatomic nor echocardiographic characteristics were predictive for later HAVB. CONCLUSIONS New-onset left BBB and diabetes mellitus independently predicted HAVB requiring PPM after TAVR and helped to identify patients at risk. Electrophysiologic study (EPS) of atrioventricular conduction was neither specific nor predictive of HAVB and can be skipped. TRIAL REGISTRATION NUMBER NCT04128384 ( https://www. CLINICALTRIALS gov ).
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10
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Pozetti AH, Ribeiro HB. Conduction Disturbances Associated with Transcatheter Aortic Valve Implantation: Challenge for another 20 Years? Arq Bras Cardiol 2022; 119:531-532. [PMID: 36287408 PMCID: PMC9563871 DOI: 10.36660/abc.20220619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Hélio Pozetti
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.,Hospital Samaritano Paulista , São Paulo , SP - Brasil
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11
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Zahid S, Khan MZ, Ullah W, Tanveer Ud Din M, Abbas S, Ubaid A, Khan MU, Rai D, Baibhav B, Rao M, Singla A, Goldsweig AM, Depta JP, Balla S. In-hospital outcomes of TAVR patients with a bundle branch block: Insights from the National Inpatient Sample 2011-2018. Catheter Cardiovasc Interv 2022; 100:424-436. [PMID: 35842779 DOI: 10.1002/ccd.30341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/18/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited. METHODS We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes. RESULTS Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups. CONCLUSION In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad Z Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Mian Tanveer Ud Din
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sakina Abbas
- Department of Medicine, Dow Medical College, Karachi, Pakistan
| | - Aamer Ubaid
- Department of Medicine, University of Missouri-Kansas City, Kansas city, Missouri, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Bipul Baibhav
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Atul Singla
- Division of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
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Pinto RA, Proença T, Carvalho MM, Pestana G, Lebreiro A, Adão L, Macedo F. Dependência de Pacing a Longo-Prazo e Preditores de Implante de Pacemaker após Implante Percutâneo de Prótese Valvular Aórtica – 1 Ano de Seguimento. Arq Bras Cardiol 2022; 119:522-530. [PMID: 35857943 PMCID: PMC9563875 DOI: 10.36660/abc.20210613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Fundamento Os distúrbios de condução (DC) são a complicação mais frequente após a substituição da válvula aórtica transcateter (TAVR) e ainda não há consenso sobre seu tratamento. Objetivo Avaliar novos DC e implante de marca-passo definitivo (MPD) após a TAVR e avaliar a porcentagem de estimulação ventricular (EV) até 1 ano de acompanhamento. Métodos Pacientes submetidos a TAVR de outubro de 2014 a novembro de 2019 foram cadastrados; pacientes com MPD anterior foram excluídos. Dados clínicos, do procedimento, do ECG e do MPD foram coletados até 1 ano após o implante. O nível de significância adotado para a análise estatística foi 0,05%. Resultados Um total de 340 indivíduos foram submetidos a TAVR. O DC mais comum foi bloqueio de ramo esquerdo novo (BRE; 32,2%), sendo que 56% destes foram resolvidos após 6 meses. O bloqueio do ramo direito (BRD) foi o maior fator de risco para bloqueio atrioventricular avançado (BAV) [RC=8,46; p<0,001] e implante de MPD [RC=5,18; p<0,001], seguido de BAV de baixo grau prévio [RC=2,25; p=0,016 para implante de MPD]. Em relação às características do procedimento, válvulas de gerações mais recentes e procedimentos de válvula-em-válvula foram associados a menos DC. No total, 18,5% dos pacientes tiveram MPD implantado após a TAVR. Na primeira avaliação do MPD, pacientes com BAV avançado tinham uma porcentagem mediana de EV de 80%, e, após um ano, de 83%. Em relação aos pacientes com BRE e BAV de baixo grau, a EV mediana foi mais baixa (6% na primeira avaliação, p=0,036; 2% após um ano, p = 0,065). Conclusão O BRE foi o DC mais frequente após a TAVR, com mais da metade dos casos se resolvendo nos primeiros 6 meses. O BRD foi o principal fator de risco para BAV avançado e implante de MPD. O BAV avançado foi associado a uma porcentagem mais alta de EV no acompanhamento de 1 ano.
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Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022; 351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India). METHODS Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared. RESULTS A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval. CONCLUSIONS After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.
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Affiliation(s)
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Redondo
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Ana Serrador
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
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Reiter C, Lambert T, Kellermair J, Blessberger H, Fellner A, Nahler A, Grund M, Steinwender C. Delayed Total Atrioventricular Block After Transcatheter Aortic Valve Replacement Assessed by Implantable Loop Recorders. JACC Cardiovasc Interv 2021; 14:2723-2732. [PMID: 34949397 DOI: 10.1016/j.jcin.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the rate and time course of delayed total atrioventricular block (DT-AVB) after transcatheter aortic valve replacement (TAVR) using continuous electrocardiographic monitoring by implantable loop recorders and to identify potential predictors. BACKGROUND DT-AVB has been defined as onset more than 2 days after TAVR or after hospital discharge and is reported in 10% to 15% of patients at 30-day follow-up. To date, there is no standardized diagnostic and therapeutic algorithm to manage TAVR patients at risk for DT-AVB. METHODS Consecutive patients undergoing TAVR and simultaneous electrophysiologic testing without persistent or recurrent total atrioventricular block within 48 hours after the procedure underwent loop recorder implantation for full disclosure of atrioventricular conduction during 12-month follow-up. RESULTS DT-AVB occurred in 7 of 59 patients (11.9%), with onset between 2 days and 3 months after the procedure. Both prolongation of the PQ interval between baseline and day 2 after TAVR (OR: 1.04; 95% CI: 1.01-1.09); P = 0.032) and prolongation of the HV interval during the procedure (OR: 1.07; 95% CI: 1.02-1.14; P = 0.015) significantly predicted the onset of DT-AVB. CONCLUSIONS TAVR was associated with a considerable rate of DT-AVB of nearly 12% in this series. Prolongation of the PQ interval between baseline and day 2 and intraprocedural prolongation of the HV interval were significant predictors of DT-AVB.
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Affiliation(s)
- Christian Reiter
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Fellner
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Nahler
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Michael Grund
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
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15
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Wang T, Ou A, Xia P, Tian J, Wang H, Cheng Z. Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2021; 37:377-405. [PMID: 34775652 DOI: 10.1111/jocs.16129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/22/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a less invasive treatment than surgery for severe aortic stenosis. However, its use is restricted by the fact that many patients eventually require permanent pacemaker implantation (PPMI). This meta-analysis was performed to identify predictors of post-TAVR PPMI. METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Relevant studies that met the inclusion criteria were included in the pooling analysis after quality assessment. RESULTS After pooling 67 studies on post-TAVR PPMI risk in 97,294 patients, balloon-expandable valve use was negatively correlated with PPMI risk compared with self-expandable valve (SEV) use (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53). Meta-regression analysis revealed that history of coronary artery bypass grafting and higher Society of Thoracic Surgeons (STS) risk score increased the risk of PPMI with SEV utilization. Patients with pre-existing cardiac conduction abnormalities in 28 pooled studies also had a higher risk of PPMI (OR: 2.33, 95% CI: 1.90-2.86). Right bundle branch block (OR: 5.2, 95% CI: 4.37-6.18) and first-degree atrioventricular block (OR: 1.97, 95% CI: 1.38-2.79) also increased PPMI risk. Although the trans-femoral approach was positively correlated with PPMI risk, the trans-apical pathway showed no statistical difference to the trans-femoral pathway. The approach did not increase PPMI risk in patients with STS scores >8. Patient-prosthesis mismatch did not influence post-TAVR PPMI risk (OR: 0.88, 95% CI: 0.67-1.16). We also analyzed implantation depth and found no difference between patients with PPMI after TAVR and those without. CONCLUSIONS SEV selection, pre-existing cardiac conduction abnormality, and trans-femoral pathway selection are positively correlated with PPMI after TAVR. Pre-existing left bundle branch block, patient-prosthesis mismatch, and implantation depth did not affect the risk of PPMI after TAVR.
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Affiliation(s)
- Tongyu Wang
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Aixin Ou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ping Xia
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahu Tian
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongchang Wang
- Department of Emergency Medicine, The First Affiliated Hospital of Lanzhou Medical University, Lanzhou, China
| | - Zeyi Cheng
- Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021; 66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.
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Affiliation(s)
- Joshua D Aymond
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Francis Benn
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Cody M Williams
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - A Elise Hiltbold
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Glenn M Polin
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Paul A Rogers
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Stephen R Ramee
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - P Eugene Parrino
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Sana M Al-Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Daniel P Morin
- Ochsner Medical Center, New Orleans, LA, United States of America.
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Rajah FT, Alaamiri AA, Mahmoodurrahman M, Alhowaish TS, Aldosari SF, Hussain AO, Masuadi EM, Arifi AA, Balgaith MA, Ayoub KM, Almutairi FQ, Alanazi HA. Incidence, predictors, and clinical outcomes of permanent pacemaker insertion following transcatheter aortic valve implantation in an Arab population. J Interv Card Electrophysiol 2021; 63:545-554. [PMID: 34427830 DOI: 10.1007/s10840-021-01039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Conduction defects requiring permanent pacemaker insertion (PPI) are one of the most common complications after transcatheter aortic valve implantation (TAVI). The purpose of this study was to identify the incidence and predictors of this complication as well as to assess clinical outcomes of patients requiring PPI after TAVI in an Arab population. METHODS In this single-center, retrospective cohort analysis, all patients who underwent TAVI from 2010 to 2018 were reviewed; seventy-four independent variables were collected per patient, and multivariate analysis was performed to identify predictors. In-hospital outcomes were examined as well as 30-day and 1-year endpoints as defined by the Valve Academic Research Consortium-2. RESULTS There were 48 of 170 patients (28.2%) who required PPI within 30 days of TAVI. The median time from TAVI to PPI was 2 days (interquartile range: 0 to 5 days). Positive predictors of 30-day PPI were prior right bundle branch block (odds ratio [OR]: 4.10; 95% confidence interval [CI]: 0.37 to 0.79; p < 0.001), post-procedural development of new right bundle branch block (OR: 3.59; 95% CI: 1.07 to 12.03; p = 0.038), post-procedural development of new left bundle branch block (LBBB) (OR: 1.85; 95% CI: 1.21 to 2.84; p = 0.005), post-procedural prolongation of PR interval (OR: 1.02; 95% CI: 1.01 to 1.02; p < 0.001), and post-procedural QRS duration (OR: 1.01; 95% CI: 1.00 to 1.03; p = 0.02). However, post-procedural development of new LBBB no longer remained a significant predictor of PPI after excluding six patients with LBBB who underwent prophylactic PPI (p = 0.093). Negative predictors of 30-day PPI were the presence of diabetes (OR: 0.54; 95% CI: 037 to 0.79; p = 0.001), the use of prosthesis size 29 compared to 23 (OR: 0.55; 95% CI: 0.35 to 0.87; p = 0.010), and the use of prosthesis size 26 compared to 23 (OR: 0.31; 95% CI: 0.20 to 0.50; p < 0.001). PPI was associated with longer median hospital stay, but the result was borderline significant after multivariate adjustment (19 vs. 14 days; p = 0.052). There was no statistically significant difference in 30-day and 1-year clinical outcomes. CONCLUSION One-third of patients required PPI after TAVI. Several risk factors can identify patients at risk for PPI particularly pre-existing right bundle branch block. Further studies are needed to assess the association between PPI and negative clinical outcomes.
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Affiliation(s)
- Fares Tofailahmed Rajah
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkhaliq Ali Alaamiri
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Thamer Saad Alhowaish
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shaya Fahad Aldosari
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulwahab Omer Hussain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Emad Mohammad Masuadi
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed A Arifi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Cardiac Surgery, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Ali Balgaith
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Kamal Mohammed Ayoub
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fawaz Q Almutairi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Haitham Ahmed Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia. .,Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, P.O. Box: 22490, 1413, Riyadh, Saudi Arabia.
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Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:115-134. [PMID: 33478630 DOI: 10.1016/j.jcin.2020.09.063] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and feasible alternative to surgery in patients with symptomatic severe aortic stenosis regardless of the surgical risk. Conduction abnormalities requiring permanent pacemaker (PPM) implantation remain a common finding after TAVR due to the close proximity of the atrioventricular conduction system to the aortic root. High-grade atrioventricular block and new onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. The overall rate of PPM implantation after TAVR varies and is related to pre-procedural and intraprocedural factors. The available literature regarding the impact of conduction abnormalities and PPM requirement on morbidity and mortality is still conflicting. Pre-procedural conduction abnormalities such as right bundle branch block and LBBB have been linked with increased PPM implantation and mortality after TAVR. When screening patients for TAVR, heart teams should be aware of various anatomical and pathophysiological conditions that make patients more susceptible to increased risk of conduction abnormalities and PPM requirement after the procedure. This is particularly important as TAVR has been recently approved for patients with low surgical risk. The purpose of this review is to discuss the incidence, predictors, impact, and management of the various conduction abnormalities requiring PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Yasser Sammour
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Najdat Bazarbashi
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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Sammour Y, Sato K, Kumar A, Gajulapalli RD, Lak H, Chawla S, Banerjee K, Kaur M, Patel J, Incognito C, Svensson L, Popovic Z, Tarakji K, Wazni O, Reed GW, Yun J, Puri R, Krishnaswamy A, Kapadia SR. Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3. Catheter Cardiovasc Interv 2021; 98:E127-E138. [PMID: 33010100 DOI: 10.1002/ccd.29309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Baseline conduction abnormalities are known risk factors for permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). We sought to determine the impact of baseline right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior hemiblock (LAHB), first-degree atrioventricular block (AVB) and atrial fibrillation/flutter (AF) on TAVR outcomes. METHODS Consecutive patients who underwent transfemoral TAVR with SAPIEN-3 (S3) were included. We excluded patients with prior PPM, nontransfemoral access or valve-in-valve. RESULTS Among 886 patients, baseline RBBB was seen in 15.9%, LBBB in 6.3%, LAHB in 6.2%, first-degree AVB in 26.3% and AF in 37.5%. The rate of 30-day PPM was 10.1%. Baseline RBBB (OR 4.005; 95% CI 2.386-6.723; p < .001) and first-degree AVB (OR 1.847; 95% CI 1.133-3.009; p = .014) were independent predictors of 30 day PPM. LAHB also resulted in higher PPM rates but only in unadjusted analysis (21.8% vs. 9.4%; p = .003). Baseline LBBB and AF were associated with lower left ventricular ejection fraction (LVEF) at both baseline and 1 year after TAVR. However, Δ LVEF over time were noted to be similar with baseline LBBB (1.8% vs. 1.4%; p = .809) and AF (1.1% vs. 1.7%; p = .458). Moreover, baseline AF was also associated with higher stroke/transient ischemic attack (TIA) at 1 year (4.4% vs. 1.8%; p = .019), 1-year major adverse cardiac and cerebrovascular events (MACCE) (19.5% vs. 13.3%; p = .012) and 2 year mortality (23.5% vs. 15.2%; p = .016). None of the other baseline conduction defects affected long-term mortality or MACCE. CONCLUSION In our S3 TAVR population, baseline RBBB and first-degree AVB predicted higher PPM risk. Prior LBBB and AF were associated with lower LVEF at both baseline and 1 year. Lastly, preexisting AF was associated with higher rates of mortality, stroke/TIA, and MACCE.
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Affiliation(s)
- Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rama Dilip Gajulapalli
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jay Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cameron Incognito
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis. J Clin Med 2021; 10:jcm10122719. [PMID: 34205478 PMCID: PMC8235153 DOI: 10.3390/jcm10122719] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%–13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%–11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI.
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22
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Stankowski T, Mangner N, Linke A, Aboul-Hassan SS, Gąsior T, Muehle A, Herwig V, Harnath A, Salem M, Szłapka M, Grimmig O, Just S, Fritzsche D, Perek B. Cardiac conduction abnormalities in patients with degenerated bioprostheses undergoing transcatheter aortic valve-in-valve implantations and their impact on long-term outcomes. Int J Cardiol 2021; 330:16-22. [PMID: 33592238 DOI: 10.1016/j.ijcard.2021.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between preoperative cardiac conduction abnormalities (CCA) and long-term outcomes after transcatheter aortic valve-in-valve implantation (TAVI-VIV) remains unclear. The aim of the study was to evaluate the effects of preoperative CCA on mortality and morbidity after TAVI-VIV and to estimate the impact of new-onset CCA on postoperative outcomes. METHODS Between 2011 and 2020, 201 patients with degenerated aortic bioprostheses were qualified for TAVI-VIV procedures in two German heart centers. Cases with previously implanted permanent rhythm-controlling devices were excluded (n = 53). A total of 148 subjects met the eligibility criteria and were divided into 2 study groups according to the presence of preexisting CCA (CCA (n = 84) and non-CCA (n = 64), respectively). Early and late mortality and morbidity were evaluated. Follow-up functional status was assessed according to New York Heart Association (NYHA) classification. RESULTS There were no procedural deaths. TAVI-VIV related new-onset CCAs were observed in 35.8% patients. The 30-day permanent pacemaker implantation rate was 1.6% in non-CCA vs 9.5% in CCA group (p = 0.045). Preexisting right bundle-branch block (OR:5.01; 95%CI, 1.05-23.84) and first-degree atrioventricular block (OR:4.55; 95%CI, 1.10-18.73) were independent predictors of new pacemaker implantation. One-year and five-year probability of survival were comparable in CCA and non-CCA groups: 90.3% vs 91.8% and 68.2% vs 74.3%, respectively. Surviving patients with preexisting and new-onset CCA had a worse functional status according to NYHA classification at follow-up. CONCLUSION Preexisting and new-onset postoperative CCAs did not affect early and late mortality after TAVI-VIV procedures, however, they may have a negative impact on late functional status.
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Affiliation(s)
- Tomasz Stankowski
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany.
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | | | - Tomasz Gąsior
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Anja Muehle
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Volker Herwig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Axel Harnath
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Mohammed Salem
- Department of Cardiology, Carl-Thiem-Klinikum, Cottbus, Germany
| | - Michał Szłapka
- Department of Cardiac Surgery, Asklepios Klinik Harburg, Hamburg, Germany
| | - Oliver Grimmig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Soeren Just
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Dirk Fritzsche
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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Tschumper M, Weber L, Rickli H, Seidl S, Brenner R, Buser M, Ehl NF, Jäger-Rhomberg F, Ammann P, Maeder MT. Corrected QT Interval in Severe Aortic Stenosis: Clinical and Hemodynamic Correlates and Prognostic Impact. Am J Med 2021; 134:267-277. [PMID: 32621909 DOI: 10.1016/j.amjmed.2020.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of the electrocardiogram for risk stratification in patients with severe aortic stenosis is not established. We assessed the hemodynamic correlates and the prognostic value of the corrected QT interval (QTc) in patients with severe aortic stenosis undergoing aortic valve replacement. METHODS The QT interval was measured in a 12-lead electrocardiogram in 485 patients (age 74 ± 10 years, 57% male) with severe aortic stenosis (indexed aortic valve area 0.41 ± 0.13 cm2/m2, left ventricular ejection fraction 58 ± 12%) the day prior to cardiac catheterization. Prolonged QTc was defined as QTc >450 ms in men and QTc >470 ms in women. The outcome parameter was all-cause mortality. RESULTS Patients with prolonged QTc (n = 100; 77 men, 23 women) had similar indexed aortic valve area but larger left ventricular and left atrial size, lower left ventricular ejection fraction, more severe mitral regurgitation, lower cardiac index, and higher mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and pulmonary vascular resistance, as compared with patients with normal QTc (n = 385). After a median follow-up of 3.7 years (interquartile range, 2.6-5.2) after surgical (n = 349) or transcatheter (n = 136) aortic valve replacement, patients with prolonged QTc had higher mortality than those with normal QTc (hazard ratio 2.81 [95% confidence interval, 1.51-5.20]; P < .001). Prolonged QTc was an independent predictor of death along with more severe mitral regurgitation and higher pulmonary vascular resistance. CONCLUSIONS In patients with severe aortic stenosis, prolonged QTc is a marker of an advanced disease stage associated with an adverse hemodynamic profile and increased long-term mortality after aortic valve replacement.
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Affiliation(s)
- Maja Tschumper
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Internal Medicine, Spital Affoltern, Affoltern am Albis, Switzerland
| | - Lukas Weber
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sebastian Seidl
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Roman Brenner
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marc Buser
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Niklas F Ehl
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Peter Ammann
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Micha T Maeder
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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24
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Bruno F, D'Ascenzo F, Vaira MP, Elia E, Omedè P, Kodali S, Barbanti M, Rodès-Cabau J, Husser O, Sossalla S, Van Mieghem NM, Bax J, Hildick-Smith D, Munoz-Garcia A, Pollari F, Fischlein T, Budano C, Montefusco A, Gallone G, De Filippo O, Rinaldi M, la Torre M, Salizzoni S, Atzeni F, Pocar M, Conrotto F, De Ferrari GM. Predictors of pacemaker implantation after transcatheter aortic valve implantation according to kind of prosthesis and risk profile: a systematic review and contemporary meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:143-153. [PMID: 33289527 DOI: 10.1093/ehjqcco/qcaa089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
AIMS Permanent pacemaker implantation (PPI) may be required after transcatheter aortic valve implantation (TAVI). Evidence on PPI prediction has largely been gathered from high-risk patients receiving first-generation valve implants. We undertook a meta-analysis of the existing literature to examine the incidence and predictors of PPI after TAVI according to generation of valve, valve type, and surgical risk. METHODS AND RESULTS We made a systematic literature search for studies with ≥100 patients reporting the incidence and adjusted predictors of PPI after TAVI. Subgroup analyses examined these features according to generation of valve, specific valve type, and surgical risk. We obtained data from 43 studies, encompassing 29 113 patients. Permanent pacemaker implantation rates ranged from 6.7% to 39.2% in individual studies with a pooled incidence of 19% (95% CI 16-21). Independent predictors for PPI were age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09], left bundle branch block (LBBB) (OR 1.45, 95% CI 1.12-1.77), right bundle branch block (RBBB) (OR 4.15, 95% CI 3.23-4.88), implantation depth (OR 1.18, 95% CI 1.11-1.26), and self-expanding valve prosthesis (OR 2.99, 95% CI 1.39-4.59). Among subgroups analysed according to valve type, valve generation and surgical risk, independent predictors were RBBB, self-expanding valve type, first-degree atrioventricular block, and implantation depth. CONCLUSIONS The principle independent predictors for PPI following TAVI are age, RBBB, LBBB, self-expanding valve type, and valve implantation depth. These characteristics should be taken into account in pre-procedural assessment to reduce PPI rates. PROSPERO ID CRD42020164043.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Matteo Pio Vaira
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Susheel Kodali
- Department of Cardiology, Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinic G. Rodolico Hospital, University of Catania, Catania, Italy
| | - Josep Rodès-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Oliver Husser
- Klinik für Innere Medizin I St.-Johannes-Hospital, Dortmund, Germany
| | - Samuel Sossalla
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Michele la Torre
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Francesco Atzeni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Pocar
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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Lilly SM, Deshmukh AJ, Epstein AE, Ricciardi MJ, Shreenivas S, Velagapudi P, Wyman JF. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:2391-2411. [DOI: 10.1016/j.jacc.2020.08.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Long-Term Electrocardiographic Changes and Clinical Outcomes of Transcatheter Aortic Valve Implantation Recipients Without New Postprocedural Conduction Disturbances. Am J Cardiol 2020; 125:107-113. [PMID: 31732136 DOI: 10.1016/j.amjcard.2019.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/29/2022]
Abstract
The objective of this study was to determine the long-term (>1 year) electrocardiographic (ECG) and clinical outcomes of patients without significant changes in their electrocardiogram after transcatheter aortic valve implantation (TAVI; including patients with pre-existing ECG abnormalities). Among 772 consecutive patients who underwent TAVI in our institution, 397 patients (51%) without new ECG changes were included. TAVI patients were divided into 2 groups according to the presence of pre-existing ECG-conduction disturbances (ECG-CD: 140 patients, non-ECG-CD: 257 patients). Clinical follow-up (median: 35 [22 to 57] months) was complete in all patients but 5 (1.2%), and ECG data were available in 291 patients (84.3% of patients at risk) at a median of 29 (20 to 50) months. In the non-ECG-CD group, most patients (79.8%) remained without significant ECG changes at follow-up, and 16.9% developed first-degree atrioventricular block and/or bundle branch block over time. The rate of permanent pacemaker (PPM) implantation at follow-up was 3.5% (1.1%/year) in the non-ECG-CD group versus 15.7% (5.5%/year) in the ECG-CD group (p <0.001). The presence of pre-existing CD was an independent predictor of PPM at follow-up (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.15 to 10.16, p <0.001). The ECG-CD group exhibited a higher risk of heart failure hospitalization (non-ECG-CD: 25%, ECG-CD: 29%, log-rank p = 0.01), but not mortality (non-ECG-CD: 50%, ECG-CD: 46%, log-rank p = 0.60) at 5-year follow-up. In conclusion, the ECG remained unchanged in most TAVI recipients without new postprocedural CD. Pre-existing ECG-CD was associated with an increased risk of PPM and heart failure hospitalization at long-term follow-up. These results provide reassuring data in the era of TAVI expanding toward candidates with a longer life expectancy, and highlight the importance of a closer follow-up of those patients with pre-existing ECG-CDs.
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Rational and design of the Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry. J Electrocardiol 2019; 57:100-103. [PMID: 31629098 DOI: 10.1016/j.jelectrocard.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is currently the most frequent heart valve disease. Symptomatic severe AS has a poor prognosis and transcatheter aortic valve implantation (TAVI) is becoming the therapy of choice in these patients. Changes in the conduction tissue after the procedure constitute one of the main limitations of TAVI, with a frequent need for a definitive pacemaker. Interatrial block (IAB) is defined as a prolonged P-wave duration and is related with atrial fibrosis. The presence of IAB could be a marker of conduction tissue abnormalities at other levels. No study has specifically analyzed the role of IAB as a predictor of the need for permanent pacemaker in patients with AS undergoing TAVI. METHODS The Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry will be performed in approximately 3000 patients with severe AS treated with TAVI. A centralized analysis of baseline ECGs will study the presence and type of IAB and other ECG data (rhythm, P-wave duration, PR and QRS intervals/intraventricular conduction disorders). Clinical follow-up will be carried out by local researchers. The primary endpoint will be the requirement of permanent pacemaker during post-TAVI hospitalization. As secondary objectives, the incidence of new onset AF, stroke, or mortality during follow-up will be analyzed. Secondary endpoints will include the incidence of new onset AF, stroke, or mortality during follow-up. CONCLUSION The BIT registry will study, for the first time, the influence of previous IAB in the need of permanent pacemaker after TAVI: This large registry will also provide information regarding the association of this and other ECG parameters with prognosis.
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Rodés-Cabau J, Ellenbogen KA, Krahn AD, Latib A, Mack M, Mittal S, Muntané-Carol G, Nazif TM, Sondergaard L, Urena M, Windecker S, Philippon F. Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:1086-1106. [DOI: 10.1016/j.jacc.2019.07.014] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
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Affiliation(s)
- Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (R.G.)
| | - Andrew Wang
- Division of Cardiology, Duke University School of Medicine, Durham, NC (A.W.)
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