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.
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References
- Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med. 2010; 363: 1597-1607
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Transcatheter aortic-valve replacement with a self-expanding prosthesis.N Engl J Med. 2014; 370: 1790-1798
- PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2016; 374: 1609-1620
- Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.N Engl J Med. 2017; 376: 1321-1331
- PARTNER 2 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med. 2019; 380: 1695-1705
- 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
- STS-ACC TVT registry of transcatheter aortic valve replacement.J Am Coll Cardiol. 2020; 76: 2492-2516
- Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis.Eur Heart J. 2020; 41: 2771-2781
- Shifting trends in timing of pacemaker implantation after transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2021; 14: 232-234
- Delayed total atrioventricular block after transcatheter aortic valve replacement assessed by implantable loop recorders.JACC Cardiovasc Interv. 2021; 14: 2723-2732
- Ambulatory electrocardiographic monitoring following minimalist transcatheter aortic valve replacement.JACC Cardiovasc Intv. 2021; 14: 2711-2722
- 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
- Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives.Circulation. 2017; 136: 1049-1069
- 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
- Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2021; 14: 115-134
- Navigating the "optimal implantation depth" with a self-expandable TAVR device in daily clinical practice.JACC Cardiovasc Interv. 2020; 13: 679-688
- 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
- Permanent pacemaker reduction using cusp-overlapping projection in TAVR: a propensity score analysis.JACC Cardiovasc Interv. 2022; 15: 150-161
- Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel.J Am Coll Cardiol. 2019; 74: 1086-1106
- Immediate post-procedural 12-lead electrocardiography as predictor of late conduction defects after transcatheter aortic valve replacement.JACC Cardiovasc Intv. 2018; 11: 1509-1518
Article info
Publication history
Published online: December 05, 2022
Received in revised form:
October 7,
2022
Received:
June 13,
2022
Footnotes
Funding: none.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
