Predictors for permanent pacemaker implantation in patients undergoing transfemoral aortic valve implantation with the Edwards Sapien 3 valve

Gonska, Birgid; Seeger, Julia; Keßler, Mirjam; Keil, Alexander von; Rottbauer, Wolfgang; Wöhrle, Jochen

doi:10.1007/s00392-017-1093-2

Cited by 51 publications

(30 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The predictors of PPI after S3 implantation have been previously investigated. 19,20 In the present study, wider QRS, presence of RBBB, and first-degree AV block at baseline were associated with an increased risk for PPI after TAVI. These findings are corroborated by previous studies evaluating the association between the S3 prosthesis and the need for PPI.…”

Section: Discussionsupporting

confidence: 48%

“…These findings are corroborated by previous studies evaluating the association between the S3 prosthesis and the need for PPI. 19,20 Alternatively, in the present study, new-onset LBBB was not associated with the requirement for PPI. This finding is similar to the study by Gonska et al, 19 who showed that only first-degree AV block and RBBB before procedure were independently associated with PPI.…”

Section: Discussionsupporting

confidence: 41%

See 1 more Smart Citation

One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Dolci¹,

Vollema²,

Kley³

et al. 2019

The American Journal of Cardiology

View full text Add to dashboard Cite

Long-term evolution of new-onset conduction abnormalities and need of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) have not been extensively evaluated. We describe the incidence and time course of new conduction abnormalities and the rate of PPI with the new-generation transcatheter aortic valve prosthesis Edwards SAPIEN 3 (S3). In total, 266 patients with severe aortic stenosis who underwent TAVI were retrospectively analyzed. Twelve-lead electrocardiograms at baseline, after TAVI, at discharge, at 1-, 6-, and 12-month follow-up were evaluated to identify conduction abnormalities and PPI requirements to investigate the correlates of PPI. After TAVI, a significant increase in PR interval duration and in QRS complex width was observed. New-onset left bundle branch block was observed in 65 patients (24%) after TAVI. The number of patients with left bundle branch block was maximum at hospital discharge and decreased at 12-month follow-up (39% and 32%, respectively). Thirty-five patients (13%) required PPI during the follow-up. However, paced rhythm was only observed in 7% of the patients with a complete 12-month follow-up. Patients who underwent PPI had a higher prevalence of first-degree atrioventricular block, complete right bundle branch block, and wider QRS complex at baseline. Baseline right bundle branch block and QRS width immediately after TAVI were the only variables independently associated with PPI. In conclusion, conduction disorders have a temporary nature after TAVI and showed a trend toward stabilization during the following months. With this new-generation device, the incidence of new conduction abnormalities requiring PPI is relatively low.Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with symptomatic severe aortic stenosis (AS) and contraindications or high risk for surgical aortic valve replacement. 1 Recently, this treatment has been extended to patients with intermediate operative risk. 2 The increased life expectancy of the population together with the current expansion of the indications for TAVI toward younger and lower surgical risk patients call for efforts to obtain similar (if not better) results than surgical aortic valve replacement which is currently the preferred treatment in these subpopulations. 3 The development of conduction abnormalities and the need for permanent pacemaker implantation (PPI) is a common complication of TAVI. Using the newgeneration transcatheter aortic valves, the incidence of PPI ranges 2.3% to 36.1%. 4 This broad range of PPI incidence relies on the inclusion of patients with pre-existent conduction abnormalities, anatomical factors such as calcification of the left ventricular (LV) outflow tract, and procedural factors such as the design and depth of implantation of the transcatheter aortic valve prosthesis. Interestingly, the time course of TAVI-induced conduction abnormalities has not been fully elucidated and high-degree atrioventricular (AV) block may occur late...

show abstract

Section: Discussionsupporting

confidence: 48%

Section: Discussionsupporting

confidence: 41%

One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Dolci¹,

Vollema²,

Kley³

et al. 2019

The American Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…Baseline RBBB, LBBB, bradycardia, and AV block were higher in PPM group in the NIS dataset that was used to derive the risk score 12 and in our validation dataset (Table 2). This is consistent with available literature 9,22,23,31,33,34 . First degree AV block was associated with a higher rate of PPM in our study ( P = .001); however, as it was not one of the significant covariates in the NIS database, it was not incorporated into the scoring system.…”

Section: Discussionsupporting

confidence: 92%

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Shivamurthy

Vejpongsa

Gurung

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with severe aortic stenosis. Despite newer generation valves, atrioventricular (AV) conduction disturbance is a common complication, necessitating permanent pacemaker (PPM) implantation in about 10% of patients. Hence, it is imperative to improve periprocedural risk stratification to predict PPM implantation after TAVR. The objective of this study was to externally validate a novel risk-stratification model derived from the National Inpatient Sample (NIS) database that predicts risk of PPM from TAVR. Methods:Components of the score included pre-TAVR left and right bundle branch block, sinus bradycardia, second-degree AV block, and transfemoral approach. The scoring system was applied to 917 patients undergoing TAVR at our institution from November 2011 to February 2017. We assessed its predictive accuracy by looking at two components: discrimination using the C-statistic and calibration using the Hosmer-Lemeshow goodness of fit test.Results: Ninety patients (9.8%) required PPM. The scoring system showed good discrimination with C-statistic score of 0.6743 (95% CI: 0.618-0.729). Higher scores suggested increased PPM risk, that is, 7.3% with score ≤3, 19.23% with score 4-6, and 37.50% with score ≥7. Patients requiring PPM were older (81.4 versus 78.7 years, P = .002). Length of stay and in-hospital mortality was significantly higher in PPM group. Conclusions:The NIS database derived PPM risk prediction model was successfully validated in our database with acceptable discriminative and gradation capacity. It is a simple but valuable tool for patient counseling pre-TAVR and in identifying high-risk patients. K E Y W O R D Selectrocardiogram, electrophysiology -basic, electrophysiology -clinical, pacing

show abstract

“…Importantly, only new conduction abnormalities, those that had not been present prior to the procedure, were recorded. This study did not examine the effects of preexisting conduction abnormalities as others have done so in the past . Our study also did not focus on valve type as the long study period meant that several different models were used and this was not the emphasis of our research.…”

Section: Methodsmentioning

confidence: 99%

“…For this reason, mechanical compression from implantation of the prosthesis can lead to conduction disturbances. Clinicians often stratify baseline risks for new conduction abnormalities and PPMI based on several studied variables including: patient comorbidities, preexisting conduction abnormalities such as right bundle branch block (RBBB), aortic annular or left ventricular outflow tract calcification, procedural approach, valve type, implantation depth, and valve oversize . While these preprocedure factors are helpful to consider, specific postprocedure clinical markers associated with delayed progression to CHB are lacking.…”

Section: Introductionmentioning

confidence: 99%

Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement

Cresse

Eisenberg

Alfonso

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background: Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure.However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives:We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker.Methods: This is a single-center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes.Results: Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24-6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18-41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49-8.37]). Conclusion:Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR. K E Y W O R D SEKG, pacemaker implantation, transcatheter aortic valve replacement 846

show abstract

Predictors for permanent pacemaker implantation in patients undergoing transfemoral aortic valve implantation with the Edwards Sapien 3 valve

Abstract: In patients treated with the ES3 for symptomatic severe aortic stenosis first degree AVB and complete RBBB at baseline were independently associated with higher rates of postprocedural PPMI, whereas implantation depth and oversizing did not have an impact on PPMI.

Cited by 51 publications

References 36 publications

One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

One-Year Follow-Up of Conduction Abnormalities After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement

Contact Info

Product

Resources

About