1
|
Kupchik N, Vance S. A Case of Symptomatic Bradycardia After Valve Replacement. Am J Nurs 2024; 124:44-46. [PMID: 39051813 DOI: 10.1097/01.naj.0001027708.35102.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Collapse
Affiliation(s)
- Nicole Kupchik
- Nicole Kupchik is an independent clinical nurse specialist at Nicole Kupchik Consulting in Seattle. Sarah Vance is a critical care facility educator at Trident Medical Center in Charleston, SC. Kupchik also coordinates Strip Savvy:. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
2
|
Prajapathi S, Pradhan A. Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on! World J Cardiol 2024; 16:104-108. [PMID: 38576520 PMCID: PMC10989220 DOI: 10.4330/wjc.v16.i3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
Several anatomical, demographic, clinical, electrocardiographic, procedural, and valve-related variables can be used to predict the probability of developing conduction abnormalities after transcatheter aortic valve replacement (TAVR) that necessitate permanent pacemaker (PPM) implantation. These variables include calcifications around the device landing zone and in the mitral annulus; pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks (BBB), first- and second-degree atrioventricular blocks, as well as bifascicular and trifascicular blocks; male sex; diabetes mellitus (DM); hypertension; history of atrial fibrillation; renal failure; dementia; and use of self-expanding valves. The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR. Regardless of the side of the BBB, this study demonstrated, for the first time, a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration (above 100 ms). After a 1-year follow-up, patients who received PPM post-TAVR had a higher rate of hospitalization for heart failure and nonfatal myocardial infarction.
Collapse
Affiliation(s)
- Sudesh Prajapathi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
| |
Collapse
|
3
|
Ghazal R, Garabedian H, Sawaya F, Refaat MM. Post-TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management. J Cardiovasc Electrophysiol 2024; 35:488-497. [PMID: 38254339 DOI: 10.1111/jce.16185] [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: 08/22/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta-analyses identified preexisting right bundle branch block (RBBB), LAHB, and new-onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self-expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post-TAVR, highlighting the need for further research and standardized treatment strategies.
Collapse
Affiliation(s)
- Rachad Ghazal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Fadi Sawaya
- Structural Heart and Valve Division, American University of Beirut Medical Center, Beirut, Lebanon
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Cardiac Electrophysiology Division, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
4
|
Dong M, Wang L, Tse G, Dai T, Lv T, Zhang N, Wang L, Xiao Z, Chen T, Liu T, Ren F. LDL-C: An Important Independent Risk Factor for New-Onset Heart Block in Patients with Severe Aortic Stenosis and Heart Failure after TAVR. Rev Cardiovasc Med 2023; 24:243. [PMID: 39076697 PMCID: PMC11266780 DOI: 10.31083/j.rcm2408243] [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: 12/12/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 07/31/2024] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an effective alternative treatment for patients with aortic stenosis (AS) who have intermediate to high surgical risk or who are inoperable. However, the incidence of conduction abnormalities is high after TAVR, which can reduce the effectiveness of the surgery. Our research objective is to explore the risk factors of new-onset conduction abnormalities after TAVR, providing reference value for clinical doctors to better prevent and treat conduction abnormalities. Methods Patients who underwent TAVR were divided into those who developed heart block and those who did not. Baseline clinical characteristics, cardiac structural parameters, procedural characteristics, electrocardiogram (ECG) changes before and after TAVR ( △ = postoperative minus preoperative), and surgical complications were compared. Logistic regression was applied to identify significant risk factors for new-onset heart block. Results We studied 93 patients, of whom 34.4% developed heart blocks. Univariate logistic regression showed that prior history of malignancy, atrial fibrillation, preoperative high-level total cholesterol and low-density lipoprotein cholesterol (LDL-C), △ HR, △ QRS interval, △ QT interval, and △ QTc interval were risk factors of new-onset heart block after TAVR. Multivariate analysis showed that preoperative high-level LDL-C and △ QRS interval remained significant independent risk factors after adjusting for potential confounds. Conclusions Heart block is the most common complication of TAVR, and its significant independent risk factors include high-level LDL-C and △ QRS interval.
Collapse
Affiliation(s)
- Mei Dong
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| | - Lizhen Wang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular
Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second
Hospital of Tianjin Medical University, 300070 Tianjin, China
- School of Nursing and Health Studies, Hong Kong, Metropolitan University,
999077 Hong Kong, China
- Kent and Medway Medical School, CT2 7FS Canterbury, UK
| | - Tao Dai
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| | - Tonglian Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular
Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second
Hospital of Tianjin Medical University, 300070 Tianjin, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular
Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second
Hospital of Tianjin Medical University, 300070 Tianjin, China
| | - Lihong Wang
- Department of Ultrasound, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| | - Zhicheng Xiao
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| | - Tienan Chen
- Department of Cardiovascular Surgery, Second Hospital of Tianjin Medical
University, 300070 Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular
Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second
Hospital of Tianjin Medical University, 300070 Tianjin, China
| | - Faxin Ren
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of
Qingdao University, 264000 Yantai, Shandong, China
| |
Collapse
|
5
|
Lauten P, Costello-Boerrigter LC, Goebel B, Gonzalez-Lopez D, Schreiber M, Kuntze T, Al Jassem M, Lapp H. Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation. J Cardiovasc Dev Dis 2023; 10:230. [PMID: 37367395 PMCID: PMC10299451 DOI: 10.3390/jcdd10060230] [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: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system.
Collapse
Affiliation(s)
- Philipp Lauten
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany (B.G.); (H.L.)
| | | | | | | | | | | | | | | |
Collapse
|