Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Ureña, Marina; Webb, John G.; Tamburino, Corrado; Muñoz-García, Antonio J.; Cheema, Asim N.; Dager, Antonio; Serra, Violeta; Amat‐Santos, Ignacio J.; Barbanti, Marco; Immè, Sebastiano; Briales, Juan H. Alonso; Benítez, Luis; Lawati, Hatim Al; Cucalón, Ángela María; Blanco, Bruno García del; López, Javier; Dumont, Éric; DeLarochellière, Robert; Ribeiro, Henrique Barbosa; Nombela‐Franco, Luis; Philippon, François; Rodés‐Cabau, Josep

doi:10.1161/circulationaha.113.005479

Cited by 275 publications

(187 citation statements)

References 43 publications

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“…This is an important finding as NOP-LBBB can associate with lack of improvement in left ventricular ejection fraction, poorer functional status, and may also increase the risk of sudden death, especially in those patients with larger QRS. [18][19][20][21] Furthermore, a recent systematic review and meta-analysis including 17 studies showed that new-onset LBBB post TAVR is a marker of an increased risk of cardiac death and the need for permanent pacemaker implantation at 1-year follow-up. 21 Of note, in a previous analysis of the Brazilian registry, with fewer patients and mostly with the CoreValve bioprosthesis, BAVP was associated with an increased need for permanent pacemaker implantation.…”

Section: Discussionmentioning

confidence: 99%

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Bernardi

Ribeiro

Carvalho

et al. 2016

Circ: Cardiovascular Interventions

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T ranscatheter aortic valve replacement (TAVR) is a complex multistep procedure that has been established as a treatment option for patients with severe aortic stenosis, considered to be inoperable or at high surgical risk. 1 In experienced centers, there has been a trend toward a simplification of the procedure, moving from general anesthesia and surgical cutdown for the femoral access, to a more minimalistic approach with conscious sedation, local anesthesia, and a fully percutaneous approach.2 Likewise, during the early days of TAVR, balloon aortic valve predilatation (BAVP) was considered an essential step to prepare the calcified aortic valve for the correct positioning and deployment of bulkier transcatheter heart valves (THV). Nonetheless, in line with this trend of making the procedure more straightforward, together with the greater experience of the operators and improvement of devices and technique, the need for predilatation has been questioned. Background-Direct

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Section: Discussionmentioning

confidence: 99%

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Bernardi

Ribeiro

Carvalho

et al. 2016

Circ: Cardiovascular Interventions

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“…Atrioventricular block requiring pacemaker implantation is reported in 1% to 8% of patients with the Edwards SAPIEN valve and 19% to 42% with the Medtronic CoreValve using currently available devices. 236 The need for pacemaker implantation did not influence subsequent survival after TAVR in some studies, 237 although others have shown increased mortality in those receiving a new pacemaker. 238 Clinical predictors of complete heart block 239 include characteristics of patient status (valve calcification and preexisting right BBB) 240 and comor bidities, as well as characteristics of the procedure (depth of implantation, device profile) 241 and balloon sizing.…”

Section: Transcatheter Structural Interventionsmentioning

confidence: 98%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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“…18 As of this writing, most patients will receive a PPM within 1 week of TAVR for high-degree or CHB. 19 However, careful review of PPM indications from procedure reports from the PARTNER registry revealed a diagnosis of sick-sinus syndrome in 17 % of patients, higher than found in previously published reports. Additionally, there was a noticeable difference in PPM rates between the continued access registry and randomised trial (9.6 % versus 5.6 %), indicating that PPM insertion is partly driven by variable physician threshold.…”

Section: Timing Of Ppm Implantmentioning

confidence: 75%

Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

Lee¹,

Yeshwant²,

Chava³

et al. 2015

Arrhythmia &Amp; Electrophysiology Review

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Aortic stenosis (AS) is the most common valvular heart disease in industrialised countries with a prevalence of about 5 % in the general population aged greater than 75 years. During the past decade, transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option for patients presenting with symptomatic severe AS, who due to their advanced age and relevant comorbidities are at prohibitive risk for conventional surgery, 1 whereas surgical aortic valve replacement (SAVR) remains the gold standard for the treatment of symptomatic AS in patients with low to moderate surgical risk.2 However, many patients begin to experience AS-related symptoms late in their lives when multiple comorbidities preclude surgery as an option. As a result, before the advent of TAVR, patients considered high-or extreme-risk surgical candidates were once limited to conventional medical therapy. Ever since the first device was deployed in 2002, TAVR has enabled inoperable patients the opportunity to experience survival rates equivalent to their surgical counterparts with considerably less procedural risk.1 Therefore, the number of patients undergoing TAVR has increased steadily, and the complications related to valve implantation have been well defined.The development of atrioventricular (AV) conduction disturbances is one of the most commonly encountered complications associated with TAVR. Between 3 and 6 % of patients undergoing surgical replacement of their aortic valve will develop complete heart block (CHB), 3 while considerably higher rates have been reported in the setting of TAVR in individual studies. 4 In this review, we aim to explore the significance of conduction disturbances preceding and resulting from TAVR. We have focused on data that raise concerns around creating chronic left ventricular (LV) dyssynchrony in this patient population, either as a consequence of creating left bundle branch block (LBBB), or from chronic right ventricular (RV) pacing. Additionally, we reviewed a number of factors that predispose TAVR patients to develop conduction disturbances, and clinical factors that can be used to identify those patients likely to require permanent pacing and alternatively those in whom it may be worth waiting longer prior to committing to permanent pacemaker (PPM) implantation. Shy of unique valve designs, it has become clear there are only modest improvements an operator can make to avoid the complication of heart block and this complication is simply part of the procedure. It is critical to anticipate it and think prospectively about the ideal pacing mode for the individual patient to prevent chronic LV dyssynchrony in those patients at highest risk. Mechanisms of Heart Block Anatomical Relationship of the Cardiac Conduction System and the Aortic RootSince the 16th century when Leonardo da Vinci conducted the first known cadaveric studies of the heart, the aortic root complex has been studied extensively. With the advent of percutaneous valves, there has been renewed interest ...

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Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation

Cited by 275 publications

References 43 publications

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

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