Electrophysiological Study-Guided Permanent Pacemaker Implantation In Patients With Conduction Disturbances Following Transcatheter Aortic Valve Implantation

Autor: Raphaël P. Martins, Camille Pichard, Baptiste Polin, Marc Bedossa, Hamed Bourenane, Dominique Boulmier, Christophe Leclercq, Guillaume Leurent, Hervé Le Breton, Marielle Le Guellec, Vincent Auffret, Jacques Tomasi, D. Pavin, Vincent Galand, Sam Sharobeem, Erwan Donal, Jean-Philippe Verhoye, Nathalie Behar
Přispěvatelé: Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], No funding, Jonchère, Laurent, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Pacemaker
Artificial
Transcatheter aortic
Bundle-Branch Block
030204 cardiovascular system & hematology
Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Cardiac Conduction System Disease
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
atrioventricular block
medicine
bundle branch block
Humans
In patient
False Positive Reactions
030212 general & internal medicine
False Negative Reactions
Aged
[SDV.IB] Life Sciences [q-bio]/Bioengineering
Aged
80 and over
business.industry
Cardiac Pacing
Artificial
Aortic Valve Stenosis
Ventricular pacing
medicine.disease
Transcatheter aortic valve replacement
Optimal management
pacemaker
3. Good health
[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Electrophysiology
Treatment Outcome
Cardiology
Female
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Electrophysiological study
Permanent pacemaker
Cardiology and Cardiovascular Medicine
business
Index hospitalization
Electrophysiologic Techniques
Cardiac
Atrioventricular block
Zdroj: American Journal of Cardiology
American Journal of Cardiology, 2021, 149, pp.78-85. ⟨10.1016/j.amjcard.2021.03.014⟩
American Journal of Cardiology, Elsevier, 2021, 149, pp.78-85. ⟨10.1016/j.amjcard.2021.03.014⟩
ISSN: 0002-9149
1879-1913
DOI: 10.1016/j.amjcard.2021.03.014⟩
Popis: International audience; Conduction disturbances remain common following transcatheter aortic valve implantation (TAVI). Aside from high-degree atrioventricular block (HAVB), their optimal management remains elusive. Invasive electrophysiological studies (EPS) may help stratify patients at low or high risk of HAVB allowing for an early discharge or permanent pacemaker (PPM) implantation among patients with conduction disturbances. We evaluated the safety and diagnostic performances of an EPS-guided PPM implantation strategy among TAVI recipients with conduction disturbances not representing absolute indications for PPM. All patients who underwent TAVI at a single expert center from June 2017 to July 2020 who underwent an EPS during the index hospitalization were included in the present study. False negative outcomes were defined as patients discharged without PPM implantation who required PPM for HAVB within 6 months of the initial EPS. False positive outcomes were defined as patients discharged with a PPM with a ventricular pacing percentage < 1% at follow-up. A total of 78 patients were included (median age: 82.4 years, 38% female), among whom 35 patients (45%) received a PPM following EPS. The sensitivity, specificity, positive and negative predictive values of the EPS-guided PPM implantation strategy were 100%, 89.6%, 81.5%, and 100%, respectively. Six patients suffered a mechanical HAVB during EPS and received a PPM. These 6 patients showed PPM dependency at follow-up. In conclusion, an EPS-guided PPM implantation strategy for managing post-TAVI conduction disturbances appears effective to identify patients who can be safely discharged without PPM implantation.
Databáze: OpenAIRE
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