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Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis

M. Droppa, TK. Rudolph, J. Baan, NE. Nielsen, H. Baumgartner, J. Vendrik, M. Froehlich, O. Borst, J. Wöhrle, M. Gawaz, P. Potratz, LP. Hack, V. Mauri, J. Baranowski, P. Bramlage, J. Kurucova, M. Thoenes, W. Rottbauer, T. Geisler,

. 2020 ; 35 (12) : 1735-1745. [pub] 20200626

Language English Country Japan

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc20027605

Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01-2.59), QRS duration > 117 ms (OR 2.58; 95% CI 1.73-3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39-7.72), left anterior hemi block (OR 1.92; 95% CI 1.19-3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05-2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19-21.86) and first-degree AVB (OR 2.39; 95% CI 1.18-4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07-4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35-2.59), mean TAVI valve implantation depth below the annulus > 30% (OR 3.75; 95% CI 2.01-6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%; p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes.Clinical Trial: NCT03497611.

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$a Droppa, Michal $u Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany.
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$a Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis / $c M. Droppa, TK. Rudolph, J. Baan, NE. Nielsen, H. Baumgartner, J. Vendrik, M. Froehlich, O. Borst, J. Wöhrle, M. Gawaz, P. Potratz, LP. Hack, V. Mauri, J. Baranowski, P. Bramlage, J. Kurucova, M. Thoenes, W. Rottbauer, T. Geisler,
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$a Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01-2.59), QRS duration > 117 ms (OR 2.58; 95% CI 1.73-3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39-7.72), left anterior hemi block (OR 1.92; 95% CI 1.19-3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05-2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19-21.86) and first-degree AVB (OR 2.39; 95% CI 1.18-4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07-4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35-2.59), mean TAVI valve implantation depth below the annulus > 30% (OR 3.75; 95% CI 2.01-6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%; p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes.Clinical Trial: NCT03497611.
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$a Rudolph, Tanja K $u Department of Cardiology, Heart Center, Cologne University, Cologne, Germany. Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
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$a Baan, Jan $u Heart Center, Academic Medical Center, Amsterdam University, Amsterdam, Netherlands.
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$a Nielsen, Niels-Erik $u Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
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$a Baumgartner, Helmut $u Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany.
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$a Gawaz, Meinrad $u Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany.
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$a Mauri, Victor $u Department of Cardiology, Heart Center, Cologne University, Cologne, Germany.
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$a Bramlage, Peter $u Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
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$a Kurucova, Jana $u Edwards Lifesciences, Prague, Czech Republic.
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$a Thoenes, Martin $u Edwards Lifesciences, Nyon, Switzerland.
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$a Rottbauer, Wolfgang $u Department of Internal Medicine II, Cardiology, Angiology, Pulmonology, Intensive Care Medicine, University of Ulm, Ulm, Germany.
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$a Geisler, Tobias $u Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany. tobias.geisler@med.uni-tuebingen.de.
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