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. 2021 Aug;61(2):365-374.
doi: 10.1007/s10840-020-00813-y. Epub 2020 Jul 15.

Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement

Derek Q Phan  1 , Jesse Goitia  1 , Ming-Sum Lee  1 , Nigel Gupta  2 , Vicken Aharonian  3 , Prakash Mansukhani  3 , Naing Moore  3 , Somjot S Brar  3 , Ray Zadegan  4
Affiliations

Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement

Derek Q Phan et al. J Interv Card Electrophysiol. 2021 Aug.

Abstract

Purpose: Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring pacemaker (PPM) implantation are a known complication and may be reversible. Therefore, we sought to evaluate the incidence and predictors for atrioventricular (AV) conduction recovery after TAVR.

Methods: A single-center, retrospective study of patients undergoing PPM implantation for conduction disorders after TAVR between June 2011 and March 2019. Conduction recovery was defined as ≤ 1% ventricular pacing (VP) on follow-up PPM interrogation.

Results: A total of 110 patients (mean age 83.6 ± 6.6 years, 46.8% female) were included. At a median follow-up of 438 days (interquartile range [IQR] 111-760 days), 35 patients (32%) had conduction recovery, with 50% of these occurring within the first 6 months. On multivariate analysis, predictors of conduction recovery include female sex (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.01-6.4, p = 0.048), non-VP/non-complete heart block rhythm immediately post-TAVR (HR 5.2, 95% CI 1.5-18.1, p = 0.011), normal sinus rhythm 7 days post-TAVR (HR 3.9, 95% CI 1.7-9.2, p = 0.002), and smaller valve size (mm) (HR 0.81, 95% CI 0.7-0.996, p = 0.045). Significant narrowing of the QRS and resolution of new-onset left bundle branch block within 1 month post-TAVR occurred in those with conduction recovery on PPM interrogation.

Conclusions: One-third of patients receiving new PPM implantation have conduction recovery after TAVR, with 50% occurring within the first 6 months. Patient gender, valve size, and rhythm on serial ECGs after TAVR can help identify patients that may recover AV conduction. A conservative approach rather than immediate PPM implantation may be considered in these patients.

Keywords: Conduction disease; Electrocardiogram; Permanent pacemaker; Transcatheter aortic valve replacement.

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References

    1. Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, et al. STS/ACC TVT Registry. 2016 annual report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol. 2017;69(10):1215–30. https://doi.org/10.1016/j.jacc.2016.11.033 . - DOI - PubMed
    1. Fadahunsi OO, Olowoyeye A, Ukaigwe A, Li Z, Vora AN, Vemulapalli S, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv. 2016;9(21):2189–99. https://doi.org/10.1016/j.jcin.2016.07.026 . - DOI - PubMed
    1. Maan A, Refaat MM, Heist EK, Passeri J, Inglessis I, Ptaszek L, et al. Incidence and predictors of pacemaker implantation in patients undergoing transcatheter aortic valve replacement. Pacing Clin Electrophysiol. 2015;38(7):878–86. https://doi.org/10.1111/pace.12653 . - DOI - PubMed
    1. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2016;9(5):e003635. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003635 . - DOI - PubMed
    1. Khatri PJ, Webb JG, Rodés-Cabau J, Fremes SE, Ruel M, Lau K, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158(1):35–46. https://doi.org/10.7326/0003-4819-158-1-201301010-00007 . - DOI - PubMed

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