Incidence, Predictors, and Management of Conduction Disturbances After Transcatheter Tricuspid Valve Replacement: The TRIPLACE Registry.
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Scotti Andrea, Puri Rishi, Sturla Matteo, Zahr Firas, Boone Robert, Kodali Susheel, Tchétché Didier, De Backer Ole, Coisne Augustin, Ludwig Sebastian, Stolz Lukas, Estevez Loureiro Rodrigo, Adam Matti, De Marco Federico, Ho Edwin C, Cheung Anson, Moey Melissa, Ong Geraldine, Chadderdon Scott, Lulic Davorka, Bartkowiak Joanna, Echarte Julio, Sievert Horst, Byrne Timothy, Maisano Francesco, Frerker Christian, Dumonteil Nicolas, Oliva Omar A, Rudolph Tanja K, Kirchner Johannes, Bakhtadze Beka, Kapadia Samir R, Rodés-Cabau Josep, Schofer Niklas, Granada Juan, Hausleiter Jörg, Hahn Rebecca T, Modine Thomas, Fam Neil, Latib Azeem
Аннотация
OBJECTIVES: The aim of this study was to investigate the incidence, predictors, and management of conduction disturbances after TTVR.
METHODS: All consecutive patients undergoing TTVR in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were analyzed. The primary endpoint was the occurrence of HAVB at 1 month post-TTVR.
RESULTS: Of 263 TTVR patients, 75 (28.5%) were excluded because of pre-existing PPI and 3 (1.1%) because of surgical conversion. At 1 month, HAVB had occurred in 25 of the remaining 185 patients (13.5%), 88% within the first week post-TTVR (median 3.0 days; Q1-Q3: 2.0-5.0). New-onset right bundle branch block was observed in 20.6% of patients. Baseline left bundle branch block or left anterior or posterior fascicular block (adjusted OR: 3.63; 95% CI: 1.28-10.37; P = 0.016) was independently associated with HAVB, after adjusting for age and degree of device oversizing. PPI was performed using leadless technologies (45.5%), coronary sinus leads (27.3%), or transvalvular dual-chamber pacemakers (27.3%).
CONCLUSIONS: HAVB occurred in 13.5% of PPI-naive patients who underwent TTVR. The majority of cases of HAVB (88%) were observed in the first week after TTVR. Baseline left bundle branch block or left anterior or posterior fascicular block confers a high risk for HAVB after TTVR. (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement [TRIPLACE]; NCT06033274).