Objective-To determine the rate of late complications following first implantation or elective unit replacement of a permanent pacemaker system. Design-Analysis of pacemaker data and complications prospectively acquired on a computerised database. Complications were studied over an 11 year period from January 1984 to December 1994. Setting-Tertiary referral cardiothoracic centre. Patients-Records of 2621 patients were analysed retrospectively. Main outcome measures-Complications requiring repeat procedures occurring more than six weeks after pacemaker implantation or elective unit replacement. Results-The overall rate of late complications was significantly lower after first implantation of a permanent pacemaker (34 cases, complication rate 1.4%, 95% confidence interval 0.9% to 1.9%) than after elective unit replacement (16 cases, complication rate 6.5% (3.3% to 9.7%). There were 20 cases of erosion, 18 infections, five electrode problems, and seven miscellaneous problems. Complications were more common with inexperienced operators (18.9% (6.0% to 31.8%)) than with experienced operators (0.9% (0.3% to 1.5%)). Conclusions-The incidence of late complications following pacemaker implantation is low and compares favourably with early complication rates. The majority are caused by erosion and infection. Patients who have undergone elective unit replacement are at particular risk. (Heart 1998;80:240-244)

Funding Acknowledgements Type of funding sources: None. Aims The COVID-19 pandemic has led to a decline in hospitalizations for non-COVID-19 related conditions. We explored the impact of the COVID-19 pandemic on cardiac operations and interventions undertaken in England. Methods An administrative database covering hospital activity for England, the Health Episodes Statistics, was used to assess a total of 286,697 hospitalizations for cardiac operations and interventions, as well as 227,257 hospitalizations for myocardial infarction (MI) and 453,799 for heart failure (HF) from 7th January 2019 to 26th July 2020. Results Over the 3 months of ‘lockdown’, total numbers and mean reductions in weekly rates (n [-%]), compared with the same time period in 2019, were: coronary artery bypass grafting (-2507 [-64%]); percutaneous coronary intervention (-5245 [-28%]; surgical (-1324 [-41%]) and transcatheter (-284 [-21%]) aortic valve replacement; mitral valve replacement; implantation of pacemakers (-6450 [-44%]), cardiac resynchronization therapy with (-356 [-42%]) or without (-491 [-46%] defibrillation devices, and implantable cardioverter defibrillators (-501 [-45%]); atrial fibrillation ablation (-1902 [-83%]), and other ablations (-1712 [-64%]) (all p < 0.001). Over this period, there were 21,038 fewer procedures than in the reference period in 2019 (p < 0.001). These changes paralleled reductions in hospitalizations for MI (-10,794 [-27%]) and HF (-63,058 [-28%]) (both p < 0.001). Conclusions The COVID-19 pandemic has led to substantial reductions in the number of cardiac operations and interventions undertaken. An alternative strategy for healthcare delivery to patients with cardiac conditions during the COVID-19 pandemic is urgently needed. Abstract Figure.

Introduction New onset left bundle branch block (LBBB) is the most common conduction disturbance associated with transcatheter aortic valve implantation (TAVI). It has been shown to adversely affect cardiac function and increase re-hospitalisation, although its impact on mortality remains contentious. Methods We conducted an observational cohort analysis of all TAVI procedures performed by 13 heart teams in the United Kingdom from inception of their structural programmes until 31st July 2013. The primary outcome was 1-year all-cause mortality. Secondary outcomes included left ventricular ejection fraction (LVEF) at 30 days and need for a post-TAVI permanent pacemaker (PPM). Results 1785 patients were eligible for inclusion to the study. The primary analysis cohort was composed of 1409 patients with complete electrocardiographic (ECG) data pre- and post-TAVI. Pre-existing LBBB was present in 200 (14.2%) patients. New LBBB occurred in 323 (22.9%) patients post TAVI, which resolved in 99 (7%) patients prior to discharge. A balloon-expandable device was implanted in 968 (69%) patients, whilst 421 (30%) patients received a self-expandable valve. New LBBB was observed in 120 (12.4%) and 192 (45.6%) patients receiving a balloon- or self-expandable prosthesis respectively. Overall 1-year all-cause mortality post TAVI was 18.7%. New onset LBBB was not associated with an increase in 1-year all-cause mortality (p=0.416). Factors that were associated with mortality included an increasing logistic EuroScore (p=0.05), history of previous balloon aortic valvuloplasty (p=0.001), renal impairment (p=0.003), previous myocardial infarction with pre-existing LBBB (p=0.028) and atrial fibrillation (p=0.039). Lower baseline peak and mean AV gradients were also associated with greater mortality at 1 year (p=0.001), likely reflecting underlying left ventricular dysfunction. In the majority of patients, LVEF remained unchanged following TAVI. Interestingly, the presence or absence of new onset LBBB did not affect LVEF improvement at 30 days. 10% of patients required a PPM post TAVI. Predictors of PPM included new LBBB (OR 2.6, p<0.001), pre-TAVI left ventricular systolic impairment (OR 1.2, p=0.037), a self-expandable device (p<0.001), and pre-existing RBBB (OR 4.0, p<0.001). Conclusions These findings suggest that new onset LBBB post TAVI does not increase mortality at 1 year or adversely affect LVEF at 30 days. Funding Acknowledgement Type of funding source: None

Conclusion NT-proBNP is related to severity of valvular AS and provides independent prognostic information for an adverse outcome. However, this predictive value is limited to conservatively treated patients. Thus, our data suggest that NT-proBNP assessment may be of incremental value in deciding on the optimal timing of valve replacement. In contrast, NT-proBNP assessment provides no additional prognostic information for patients undergoing valve replacement.