Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement

Doshi, Rajkumar; Decter, Dean; Meraj, Perwaiz

doi:10.1002/clc.22943

Cited by 12 publications

(6 citation statements)

References 32 publications

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“…The most common arrhythmia in our population, atrial fibrillation (2.87%) is lower than the reported 4% incidence in the general surgery population 11 . The finding that atrial fibrillation as the commonest arrythmia in our cohort, compares well with prior analyses using the NIS for various disease states 5,8,9,13 . It has been hypothesized that low testosterone in transgender females may increase the risk for atrial and ventricular arrhythmia 14 .…”

Section: Discussionsupporting

confidence: 68%

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Burden of arrythmias in transgender patients hospitalized for gender‐affirming surgeries

Antwi‐Amoabeng

Doshi

Adalja

et al. 2020

Journal of Arrhythmia

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Background We sought to describe the burden of arrhythmias and their impact on in‐hospital outcomes in transgender patients who underwent gender re‐assignment surgery. Methods The study utilized data from the National Inpatient Sample from January 2012 to September 2015. Results 16 555 adult transgender patients were included in this study. A total of 610 adults developed arrhythmia out of which atrial fibrillation (N = 475, 2.87%) was the most frequent arrhythmia. In‐hospital mortality increased substantially with arrhythmias. Conclusions New‐onset arrythmias, while infrequent in the inpatient setting is associated with significantly higher in‐hospital mortality and resource utilization.

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Section: Discussionsupporting

confidence: 68%

“…New‐onset arrhythmias were identified using ICD‐9‐CM diagnosis codes in the secondary columns. This method and ICD‐9‐CM codes have been utilized in the past 8‐10 . We used Jonckheere‐Terpstra trend analysis for assessment of the trend in gender‐affirming surgeries from January 2012 to September 2015.…”

Section: Methodsmentioning

confidence: 99%

Burden of arrythmias in transgender patients hospitalized for gender‐affirming surgeries

Antwi‐Amoabeng

Doshi

Adalja

et al. 2020

Journal of Arrhythmia

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“…Table 1 shows the baseline characteristics of the included studies. The 36 studies included a total of 55,851 patients in the final analysis, from 2005 to 2018 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. The mean age of the patients was 81.9 years, with a mean STS score of 8.3.…”

Section: Resultsmentioning

confidence: 99%

“…The influence of RBBB on post-TAVI PPI was significant, with OR 4.8581 (4.1571; 5.6775), p < 0.0001 with moderate heterogeneity I 2 = 63.4% [45.1%; 75.6%] and no publication bias ( p = 0.937) ( Figure 3 ). The baujat plot ( Supplementary Figure S12 ) shows that two studies [ 36 , 37 ] may impact the heterogeneity. Sensitivity analysis confirms the impact of RBBB on the post-TAVI PPI rate even at the leave-one out analysis ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

Ravaux

Mauro

Vernooy

et al. 2021

JCM

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Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%–13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%–11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI.

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“…Post-TAVR conduction abnormalities needing pacemaker placement are well-documented and, furthermore, have been described with greater frequency in TAVR with an incidence ranging from 5%-22% [25]. The proliferation of TAVR has increased the need for pacing post-implantation, with literature to date focusing on factors predicting the need for post-implant device therapy, including anatomical factors, type of prosthesis, and underlying conduction abnormalities [26]. Device therapy in this setting has been previously associated with increased length of stay, increased mortality, and, as our study more clearly highlights, increased cost [27].…”

Section: Discussionmentioning

confidence: 99%

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis

Ahmad

Patel

Loc

et al. 2019

Cureus

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Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions.

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Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement

Abstract: A risk stratification for hospitalizations with conduction disorders is necessary to avoid longer hospital stays, added costs, and mortality. Further research is warranted to investigate additional predictors for PPM after TAVR.

Cited by 12 publications

References 32 publications

Burden of arrythmias in transgender patients hospitalized for gender‐affirming surgeries

Burden of arrythmias in transgender patients hospitalized for gender‐affirming surgeries

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis

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