Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement
| Autor: | Ray Zadegan, Nigel Gupta, Jesse Goitia, Derek Q Phan, Vicken Aharonian, Somjot S Brar, Prakash Mansukhani, Ming-Sum Lee, Naing Moore |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Heart block medicine.medical_treatment 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences QRS complex 0302 clinical medicine Valve replacement Risk Factors Interquartile range Physiology (medical) Internal medicine medicine Humans 030212 general & internal medicine Atrioventricular Block Retrospective Studies Aged 80 and over business.industry Left bundle branch block Hazard ratio Cardiac Pacing Artificial Aortic Valve Stenosis medicine.disease Confidence interval Treatment Outcome Aortic Valve Cardiology Female Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | Journal of Interventional Cardiac Electrophysiology. 61:365-374 |
| ISSN: | 1572-8595 1383-875X |
| Popis: | Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring pacemaker (PPM) implantation are a known complication and may be reversible. Therefore, we sought to evaluate the incidence and predictors for atrioventricular (AV) conduction recovery after TAVR. A single-center, retrospective study of patients undergoing PPM implantation for conduction disorders after TAVR between June 2011 and March 2019. Conduction recovery was defined as ≤ 1% ventricular pacing (VP) on follow-up PPM interrogation. A total of 110 patients (mean age 83.6 ± 6.6 years, 46.8% female) were included. At a median follow-up of 438 days (interquartile range [IQR] 111–760 days), 35 patients (32%) had conduction recovery, with 50% of these occurring within the first 6 months. On multivariate analysis, predictors of conduction recovery include female sex (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.01–6.4, p = 0.048), non-VP/non-complete heart block rhythm immediately post-TAVR (HR 5.2, 95% CI 1.5–18.1, p = 0.011), normal sinus rhythm 7 days post-TAVR (HR 3.9, 95% CI 1.7–9.2, p = 0.002), and smaller valve size (mm) (HR 0.81, 95% CI 0.7–0.996, p = 0.045). Significant narrowing of the QRS and resolution of new-onset left bundle branch block within 1 month post-TAVR occurred in those with conduction recovery on PPM interrogation. One-third of patients receiving new PPM implantation have conduction recovery after TAVR, with 50% occurring within the first 6 months. Patient gender, valve size, and rhythm on serial ECGs after TAVR can help identify patients that may recover AV conduction. A conservative approach rather than immediate PPM implantation may be considered in these patients. |
| Databáze: | OpenAIRE |
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