Anatomical characteristics of the membranous septum are predictive of pacemaker requirement in patients undergoing transcatheter aortic valve replacement

Na, Jonathan; Nixon, Bryan; Childress, James F.; Han, Paul K. J.; Norcross, Gregory; Liskov, Steven; Jeudy, Jean; Restrepo, Alejandro

doi:10.1007/s10840-021-01041-8

Cited by 3 publications

(11 citation statements)

References 26 publications

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“…We had ourselves previously discussed the variability in the morphology of the membranous septum (De Almeida et al, 2021; Mori et al, 2018). The importance of such variability has now been emphasized in recent clinical studies (Jilaihawi et al, 2019; Jørgensen et al, 2021; Na et al, 2021). We were able to assess these features in our overall group of hearts sectioned parallel to the base of the triangle of Koch.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the excellence of the results of transcatheter replacement of the aortic valve, disturbances of atrioventricular conduction remain a matter of concern (Auffret et al, 2017; Jilaihawi et al, 2019; Jørgensen et al, 2021; Na et al, 2021; Piazza et al, 2008; Sammour et al, 2021; Tretter et al, 2019). Pre‐ and post‐balloon dilation of the outflow tract, oversizing the diameter of the prosthesis to be implanted, and use of self‐expanding or mechanically‐expanding valves are all known to increase the risk of such conduction disturbances.…”

Section: Discussionmentioning

confidence: 99%

“…At present, interventionists usually take the inferior margin of the membranous septum as the surrogate for the location of the conduction axis. When assessed using computed tomography, however, the measurement from the virtual basal plane to this inferior margin does not consistently predict the need either for insertion of a permanent pacemaker, or the occurrence of left bundle branch block (Jilaihawi et al, 2019; Na et al, 2021). The depth of valvar implantation, nonetheless, was highly predictive of conduction disturbances (Jørgensen et al, 2021; Na et al, 2021; Tretter et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…When assessed using computed tomography, however, the measurement from the virtual basal plane to this inferior margin does not consistently predict the need either for insertion of a permanent pacemaker, or the occurrence of left bundle branch block (Jilaihawi et al, 2019; Na et al, 2021). The depth of valvar implantation, nonetheless, was highly predictive of conduction disturbances (Jørgensen et al, 2021; Na et al, 2021; Tretter et al, 2019). This suggests that other anatomical variables might dictate the vulnerability of the conduction axis.…”

Section: Discussionmentioning

confidence: 99%

“…Its rightward wall is formed by the atrioventricular component of the membranous septum, which on occasion can be fibromuscular rather than purely fibrous. This variation should now be taken into account when seeking to assess the anatomical features which may impact on the vulnerability of the atrioventricular conduction axis (Jilaihawi et al, 2019; Na et al, 2021; Tretter et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

et al. 2021

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Conduction problems still occur following transcatheter aortic valvar replacement.With this in mind, we have assessed the relationship of the conduction axis to the aortic root. We used serial histological sections, made perpendicular to the base of the triangle of Koch in nine hearts, and perpendicular to the aortic root in 11 hearts.We first defined the extent of the fibrous tissues forming the boundaries of an infero-septal recess of the subaortic outflow tract, found in all datasets but one.When the recess was present, the axis penetrated through its rightward wall, giving rise to the left bundle branch prior to entering the outflow tract. The axis itself was usually on the crest of the ventricular septum, but could be deviated leftward or rightward. Its proximity to the virtual basal plane reflected the angulation of the muscular septum. On average, the superior edge of the left bundle was within 3.3 mm of the hinge of the right coronary leaflet, with a range from 0.4 to 10.2 mm. The arrangement was markedly different in the case lacking an infero-septal recess. Our findings necessitated a redefinition of the right fibrous trigone and the central fibrous body. The atrioventricular conduction axis, having entered the aortic root, is usually closest at the hinge of the right coronary leaflet. Knowledge of the depth of the infero-septal recess, and the angulation of the muscular ventricular septal, may help to avoid conduction problems following transcatheter implantation of the aortic valve.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

et al. 2021

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Computed tomography to predict pacemaker need after transcatheter aortic valve replacement

Verhemel,

Nuis,

van den Dorpel

et al. 2024

Journal of Cardiovascular Computed Tomography

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Novel predictors of permanent pacemaker implantation following transcatheter aortic valve replacement

Nwaedozie,

Zhang,

Najjar Mojarrab

et al. 2023

World J Cardiol

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BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers (PPM) are short-term complications following transcatheter aortic valve replacement (TAVR), and their clinical outcomes remain conflicting. Potential novel predictors of post-TAVR PPM, like QRS duration, QTc prolongation, and supraventricular arrhythmias, have been poorly studied. AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes. METHODS A retrospective cohort study that identified patients with TAVR between January 1, 2012 to December 31, 2019. The group was dichotomized into those with post-TAVR PPM and those without PPM. Both groups were followed for one year. RESULTS Out of the 357 patients that met inclusion criteria, the mean age was 80 years, 188 (52.7%) were male, and 57 (16%) had a PPM implantation. Baseline demographics, valve type, and cardiovascular risk factors were similar except for type II diabetes mellitus (DM), which was more prevalent in the PPM cohort (59.6% vs 40.7%; P = 0.009). The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block, prolonged QRS > 120 ms, prolonged QTc > 470 ms, and supraventricular arrhythmias. There was a consistently significant increase in the odds ratio (OR) of PPM implantation for every 20 ms increase in the QRS duration above 100 ms: QRS 101-120 [OR: 2.44; confidence intervals (CI): 1.14-5.25; P = 0.022], QRS 121-140 (OR: 3.25; CI: 1.32-7.98; P = 0.010), QRS 141-160 (OR: 6.98; CI: 3.10-15.61; P < 0.001). After model adjustment for baseline risk factors, the OR remained significant for type II DM (aOR: 2.16; CI: 1.18-3.94; P = 0.012), QRS > 120 (aOR: 2.18; CI: 1.02-4.66; P = 0.045) and marginally significant for supraventricular arrhythmias (aOR: 1.82; CI: 0.97-3.42; P = 0.062). The PPM cohort had a higher adjusted OR of heart failure (HF) hospitalization (aOR: 2.2; CI: 1.1-4.3; P = 0.022) and nonfatal myocardial infarction (MI) (aOR: 3.9; CI: 1.1-14; P = 0.031) without any difference in mortality (aOR: 1.1; CI: 0.5-2.7; P = 0.796) at one year. CONCLUSION Pre-TAVR type II DM and QRS duration > 120, regardless of the presence of bundle branch blocks, are predictors of post-TAVR PPM. At 1-year post-TAVR, patients with PPM have higher odds of HF hospitalization and MI.

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Anatomical characteristics of the membranous septum are predictive of pacemaker requirement in patients undergoing transcatheter aortic valve replacement

Cited by 3 publications

References 26 publications

The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

Computed tomography to predict pacemaker need after transcatheter aortic valve replacement

Novel predictors of permanent pacemaker implantation following transcatheter aortic valve replacement

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