Advertisement

Permanent Pacemaker Insertion Reduction and Optimized Temporary Pacemaker Management After Contemporary Transcatheter Aortic Valve Implantation With Self-Expanding Valves (from the Pristine TAVI Study)

Published:December 05, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.11.026
      Permanent pacemaker implantation (PPMI) reduction and optimal management of newly acquired conduction disturbances after transcatheter aortic valve implantation (TAVI) are crucial. We sought to evaluate the relation between transcatheter heart valve (THV) implantation depth and baseline and newly acquired conduction disturbances on PPMI after TAVI. This study included 1,026 consecutive patients with severe symptomatic aortic stenosis (mean age 79.7 ± 8.4 years; 47.4% female) who underwent TAVI with the newer-generation self-expanding THVs Primary outcomes were early and late PPMI defined as the need for PPMI during the index admission and between discharge and 30 days, respectively. Early and late PPMI was required for 115 (11.2%) and 21 patients (2.0%), respectively. Early PPMI rates decreased from 26.7% in 2015 and 2016 to 5.7% in 2021, and so did the mean THV depth from 4.4 ± 2.4 mm to 1.8 ± 1.6 mm. Receiver operator characteristics curve analyses showed THV depth had significant discriminatory value for early and late PPMI with cutoff values of 3.0 and 2.2 mm, respectively. Rates of early and late PPMI were significantly lower for patients with shallower compared with deeper implantations (5.1% vs 22.6% and 0.4% vs 4.1%, p <0.001 for both, respectively). Furthermore, rates of early PPMI were lower with shallower implantations in patients with new left bundle branch block after TAVI (2.4% vs 15.9%; p <0.001) and those with baseline right bundle branch block (7.5% vs 29.6%; p = 0.017). Lower rates of PPMI with shallower THV implantation were consistently observed, including in patients with baseline and newly acquired conduction disturbances. Our findings might help optimize the management of a temporary pacemaker after TAVI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Leon MB
        • Smith CR
        • Mack M
        • Miller DC
        • Moses JW
        • Svensson LG
        • Tuzcu EM
        • Webb JG
        • Fontana GP
        • Makkar RR
        • Brown DL
        • Block PC
        • Guyton RA
        • Pichard AD
        • Bavaria JE
        • Herrmann HC
        • Douglas PS
        • Petersen JL
        • Akin JJ
        • Anderson WN
        • Wang D
        • Pocock S
        • PARTNER Trial Investigators
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Smith CR
        • Leon MB
        • Mack MJ
        • Miller DC
        • Moses JW
        • Svensson LG
        • Tuzcu EM
        • Webb JG
        • Fontana GP
        • Makkar RR
        • Williams M
        • Dewey T
        • Kapadia S
        • Babaliaros V
        • Thourani VH
        • Corso P
        • Pichard AD
        • Bavaria JE
        • Herrmann HC
        • Akin JJ
        • Anderson WN
        • Wang D
        • Pocock SJ
        • PARTNER Trial Investigators
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Adams DH
        • Popma JJ
        • Reardon MJ
        • Yakubov SJ
        • Coselli JS
        • Deeb GM
        • Gleason TG
        • Buchbinder M
        • Hermiller J
        • Kleiman NS
        • Chetcuti S
        • Heiser J
        • Merhi W
        • Zorn G
        • Tadros P
        • Robinson N
        • Petrossian G
        • Hughes GC
        • Harrison JK
        • Conte J
        • Maini B
        • Mumtaz M
        • Chenoweth S
        • Oh JK
        • U.S. CoreValve Clinical Investigators
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 370: 1790-1798
        • Leon MB
        • Smith CR
        • Mack MJ
        • Makkar RR
        • Svensson LG
        • Kodali SK
        • Thourani VH
        • Tuzcu EM
        • Miller DC
        • Herrmann HC
        • Doshi D
        • Cohen DJ
        • Pichard AD
        • Kapadia S
        • Dewey T
        • Babaliaros V
        • Szeto WY
        • Williams MR
        • Kereiakes D
        • Zajarias A
        • Greason KL
        • Whisenant BK
        • Hodson RW
        • Moses JW
        • Trento A
        • Brown DL
        • Fearon WF
        • Pibarot P
        • Hahn RT
        • Jaber WA
        • Anderson WN
        • Alu MC
        • Webb JG
        PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Reardon MJ
        • Van Mieghem NM
        • Popma JJ
        • Kleiman NS
        • Søndergaard L
        • Mumtaz M
        • Adams DH
        • Deeb GM
        • Maini B
        • Gada H
        • Chetcuti S
        • Gleason T
        • Heiser J
        • Lange R
        • Merhi W
        • Oh JK
        • Olsen PS
        • Piazza N
        • Williams M
        • Windecker S
        • Yakubov SJ
        • Grube E
        • Makkar R
        • Lee JS
        • Conte J
        • Vang E
        • Nguyen H
        • Chang Y
        • Mugglin AS
        • Serruys PW
        • Kappetein AP
        • Investigators SURTAVI
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        • Mack MJ
        • Leon MB
        • Thourani VH
        • Makkar R
        • Kodali SK
        • Russo M
        • Kapadia SR
        • Malaisrie SC
        • Cohen DJ
        • Pibarot P
        • Leipsic J
        • Hahn RT
        • Blanke P
        • Williams MR
        • McCabe JM
        • Brown DL
        • Babaliaros V
        • Goldman S
        • Szeto WY
        • Genereux P
        • Pershad A
        • Pocock SJ
        • Alu MC
        • Webb JG
        • Smith CR
        PARTNER 2 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Popma JJ
        • Deeb GM
        • Yakubov SJ
        • Mumtaz M
        • Gada H
        • O'Hair D
        • Bajwa T
        • Heiser JC
        • Merhi W
        • Kleiman NS
        • Askew J
        • Sorajja P
        • Rovin J
        • Chetcuti SJ
        • Adams DH
        • Teirstein PS
        • Zorn 3rd, GL
        • Forrest JK
        • Tchétché D
        • Resar J
        • Walton A
        • Piazza N
        • Ramlawi B
        • Robinson N
        • Petrossian G
        • Gleason TG
        • Oh JK
        • Boulware MJ
        • Qiao H
        • Mugglin AS
        • Reardon MJ
        Evolut Low Risk Trial Investigators. ITranscatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        • Carroll JD
        • Mack MJ
        • Vemulapalli S
        • Herrmann HC
        • Gleason TG
        • Hanzel G
        • Deeb GM
        • Thourani VH
        • Cohen DJ
        • Desai N
        • Kirtane AJ
        • Fitzgerald S
        • Michaels J
        • Krohn C
        • Masoudi FA
        • Brindis RG
        • Bavaria JE.
        STS-ACC TVT registry of transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2020; 76: 2492-2516
        • Faroux L
        • Chen S
        • Muntané-Carol G
        • Regueiro A
        • Philippon F
        • Søndergaard L
        • Jørgensen TH
        • Lopez-Aguilera J
        • Kodali S
        • Leon M
        • Nazif T
        • Rodés-Cabau J
        Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis.
        Eur Heart J. 2020; 41: 2771-2781
        • Mazzella AJ
        • Hendrickson MJ
        • Arora S
        • Sanders M
        • Li Q
        • Vavalle JP
        • Gehi AK.
        Shifting trends in timing of pacemaker implantation after transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2021; 14: 232-234
        • 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
        • Muntané-Carol G
        • Okoh AK
        • Chen C
        • Nault I
        • Kassotis J
        • Mohammadi S
        • Coromilas J
        • Lee LY
        • Alperi A
        • Philippon F
        • Russo MJ
        • Rodés-Cabau J.
        Ambulatory electrocardiographic monitoring following minimalist transcatheter aortic valve replacement.
        JACC Cardiovasc Intv. 2021; 14: 2711-2722
        • Otto CM
        • Nishimura RA
        • Bonow RO
        • Carabello BA
        • Erwin 3rd, JP
        • Gentile F
        • Jneid H
        • Krieger EV
        • Mack M
        • McLeod C
        • O'Gara PT
        • Rigolin VH
        • Sundt 3rd, TM
        • Thompson A
        • Toly C.
        • Writing Committee Members
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2021; 77: e25-e197
        • Auffret V
        • Puri R
        • Urena M
        • Chamandi C
        • Rodriguez-Gabella T
        • Philippon F
        • Rodés-Cabau J.
        Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives.
        Circulation. 2017; 136: 1049-1069
        • Kusumoto FM
        • Schoenfeld MH
        • Barrett C
        • Edgerton JR
        • Ellenbogen KA
        • Gold MR
        • Goldschlager NF
        • Hamilton RM
        • Joglar JA
        • Kim RJ
        • Lee R
        • Marine JE
        • McLeod CJ
        • Oken KR
        • Patton KK
        • Pellegrini CN
        • Selzman KA
        • Thompson A
        • Varosy PD.
        2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2019; 74: e51-e156
        • 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
        • Piayda K
        • Hellhammer K
        • Veulemans V
        • Sievert H
        • Gafoor S
        • Afzal S
        • Hennig I
        • Makosch M
        • Polzin A
        • Jung C
        • Westenfeld R
        • Kelm M
        • Zeus T.
        Navigating the "optimal implantation depth" with a self-expandable TAVR device in daily clinical practice.
        JACC Cardiovasc Interv. 2020; 13: 679-688
        • Hokken TW
        • Wolff QM
        • Schermers T
        • van Wiechen MP
        • Ooms JF
        • Adrichem R
        • Hirsch A
        • Budde RP
        • Daemen J
        • Van Mieghem NM.
        Cusp overlap versus 3-cusps-aligned transcatheter aortic valve depth assessment with different angiography projections by multidetector computed tomography.
        JACC Cardiovasc Interv. 2022; 15: 231-233
        • Pascual I
        • Hernández-Vaquero D
        • Alperi A
        • Almendarez M
        • Avanzas P
        • Kalavrouziotis D
        • Lorca R
        • Mesnier J
        • Arboine L
        • Mohammadi S
        • Valle RD
        • Dumont E
        • Leon V
        • De Larochelliere R
        • Rodés-Cabau J
        • Moris C
        Permanent pacemaker reduction using cusp-overlapping projection in TAVR: a propensity score analysis.
        JACC Cardiovasc Interv. 2022; 15: 150-161
        • Rodés-Cabau J
        • Ellenbogen KA
        • Krahn AD
        • Latib A
        • Mack M
        • Mittal S
        • Muntané-Carol G
        • Nazif TM
        • Søndergaard L
        • Urena M
        • Windecker S
        • Philippon F.
        Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel.
        J Am Coll Cardiol. 2019; 74: 1086-1106
        • Jørgensen TH
        • De Backer OD
        • Gerds TA
        • Bieliauskas G
        • Svendsen JH
        • Søndergaard L.
        Immediate post-procedural 12-lead electrocardiography as predictor of late conduction defects after transcatheter aortic valve replacement.
        JACC Cardiovasc Intv. 2018; 11: 1509-1518