JACC. Cardiovascular interventions · 2025
Same-Day Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Fischer Quentin, Urena Marina, Muntané-Carol Guillem, Alperi Alberto, Nombela-Franco Luis, Veiga Gabriela, Regueiro Ander, Suc Gaspard, Romaguera Rafael, Avanzas Pablo, Tirado-Conte Gabriela, de la Torre Hernandez Jose M, Cepas-Guillén Pedro, Côté Mélanie, Philippon François, Rodés-Cabau Josep
Аннотация
BACKGROUND: The development of conduction disturbances leading to permanent pacemaker implantation (PPI) remains the main complication of transcatheter aortic valve replacement (TAVR).
OBJECTIVES: The aim of this study was to determine the impact of same-day PPI in patients developing persistent complete or high-degree atrio-ventricular block (CHB/HAVB) during TAVR.
METHODS: This was a multicenter study including consecutive patients without prior pacemaker and developing procedural persistent CHB/HAVB. Baseline, procedural, and follow-up clinical and pacing interrogation data were prospectively collected in a dedicated database.
RESULTS: A total of 584 consecutive patients (mean age: 81 ± 8 years, 50% of women) were included; 157 (26.9%) had same-day PPI (SDP), and 427 (73.1%) were observed to assess for potential conduction recovery (n-SDP). In the n-SDP group, 376 patients (88%) finally received a PPI at a median of 3 [1-4] days following TAVR. There were no differences in periprocedural complications between groups, including pacemaker pocket hematomas, and the hospitalization length was shorter in the SDP group (5 [2-7] days vs 8[4-9] days; P < 0.001). At 1-month follow-up, the median percentage of ventricular pacing (SDP: 96% (22%-99%), n-SDP: 90% (10%-99%); P = 0.203) and pacemaker dependency rate (SDP: 56%, n-SDP: 50%; P = 0.277) were similar in both groups.
CONCLUSIONS: In patients developing procedural persistent CHB/HAVB during TAVR, SDP was safe and associated with a shorter hospitalization length and a very high pacing burden at 30 days. These results, along with the very low rate of conduction recovery in the n-SDP group, would support SDP as a reasonable strategy in these patients.
OBJECTIVES: The aim of this study was to determine the impact of same-day PPI in patients developing persistent complete or high-degree atrio-ventricular block (CHB/HAVB) during TAVR.
METHODS: This was a multicenter study including consecutive patients without prior pacemaker and developing procedural persistent CHB/HAVB. Baseline, procedural, and follow-up clinical and pacing interrogation data were prospectively collected in a dedicated database.
RESULTS: A total of 584 consecutive patients (mean age: 81 ± 8 years, 50% of women) were included; 157 (26.9%) had same-day PPI (SDP), and 427 (73.1%) were observed to assess for potential conduction recovery (n-SDP). In the n-SDP group, 376 patients (88%) finally received a PPI at a median of 3 [1-4] days following TAVR. There were no differences in periprocedural complications between groups, including pacemaker pocket hematomas, and the hospitalization length was shorter in the SDP group (5 [2-7] days vs 8[4-9] days; P < 0.001). At 1-month follow-up, the median percentage of ventricular pacing (SDP: 96% (22%-99%), n-SDP: 90% (10%-99%); P = 0.203) and pacemaker dependency rate (SDP: 56%, n-SDP: 50%; P = 0.277) were similar in both groups.
CONCLUSIONS: In patients developing procedural persistent CHB/HAVB during TAVR, SDP was safe and associated with a shorter hospitalization length and a very high pacing burden at 30 days. These results, along with the very low rate of conduction recovery in the n-SDP group, would support SDP as a reasonable strategy in these patients.