Implications of pacemaker implantation after TAVR: insights from the Nationwide Readmissions Database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Sharma ◽  
W Sheikh ◽  
A Parulkar ◽  
F Lima ◽  
M Wu ◽  
...  
Keyword(s):  
Representative Sample ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Index Admission ◽  
Median Cost ◽  
Index Hospitalization ◽  
Conduction Disturbances ◽  
Propensity Matching ◽  
Bundle Branch Blocks ◽  
Nationally Representative

Abstract Introduction Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring permanent pacemaker (PPM) implantation are a well-known procedural complication. Data on the effect of post-TAVR PPM implantation on 30-day readmissions is scarce. Methods The Nationwide Readmissions Database (NRD) is a nationally representative sample of all US hospitalizations, representing over 35 million discharges. The 2016 NRD was used to identify patients who underwent TAVR and PPM implantation from January to November 2016. Propensity matching was used to balance baseline clinical characteristics. Results Of the 44,607 patients who underwent TAVR, 4,878 (10.9%) required permanent pacemaker implantation during their index hospitalization. Patients requiring PPM during their index admission for TAVR had a higher crude median length of stay (LOS) (5d vs. 3d, p<0.001), median cost of index admission ($61,604 vs. $45,513, p<0.001) and rate of 30-day readmission (14.5% vs 11.2%, p<0.001). After 2:1 propensity matching, PPM patients still had a higher median LOS (5d vs. 3d, p<0.001), median cost of index admission ($61,902 vs. $41,162, p<0.001), and rate of 30-day readmission (13.8% vs 11.1%, p=0.003). Patients who received PPM were more likely to be older (81.1 vs 80.3, OR 1.01, CI 1.01–1.02), diabetic (OR 1.27, 1.13–1.44), obese (OR 1.22, 1.05–1.43), and have right (OR 4.35, 3.72–5.09) or left (OR 1.80, 1.51–2.15) bundle branch blocks on multivariate analysis. Causes of readmission in patients with and without PPM were predominantly non-cardiac (62.9% vs 68.0%). Heart failure was the most common cause of readmission for both groups (18.4% vs 14.6%). Median cost of readmissions ($8716 vs $8250, p=0.34) and LOS (4d vs 4d, p=1) were not significantly different during readmissions. Conclusions Based on a nationally representative sample, 10.9% of patients undergoing TAVR required PPM implantation during the index hospitalization. Age, diabetes, obesity, and right or left bundle branch blocks were significant predictors of PPM implantation. PPM implantation resulted in significantly higher LOS, costs, and 30-day readmissions on propensity-matched analysis. Funding Acknowledgement Type of funding source: None

scholarly journals Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1244-1251 ◽  
Author(s):  
Nynke H M Kooistra ◽  
Martijn S van Mourik ◽  
Ramón Rodríguez-Olivares ◽  
Alexander H Maass ◽  
Vincent J Nijenhuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Pacemaker Implantation ◽  
Early Discharge ◽  
Permanent Pacemaker ◽  
Conduction Delay ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Timing Of Onset

BackgroundThe timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.Methods and resultsWe performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.ConclusionsSafe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.

scholarly journals Use of Electrophysiological Studies in Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 9 (1) ◽  
pp. 20-27
Author(s):  
Oholi Tovia-Brodie ◽  
Yoav Michowitz ◽  
Bernard Belhassen
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Transcatheter Aortic Valve ◽  
Electrophysiological Studies ◽  
Aortic Valve Implantation ◽  
Valve Implantation

New conduction disturbances requiring permanent pacemaker implantation remain common complications following transcatheter aortic valve implantation (TAVI). It has been suggested that electrophysiological studies could help identify patients who will require permanent pacemaker implantation after TAVI. This article summarises contemporary data on the use of electrophysiological studies in patients undergoing TAVI.

P3739Differences in short-term outcome between balloon- and self-expandable TAVR devices relating to more than one generation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V V Veulemans ◽  
K Klein ◽  
O Maier ◽  
G Wolff ◽  
A Polzin ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Lower Incidence ◽  
Academic Research ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Permanent Pacemaker ◽  
Bleeding Complications ◽  
Term Outcome ◽  
Pacemaker Therapy ◽  
Conduction Disturbances

Abstract Background Transcatheter aortic valve replacement (TAVR) is the treatment option of choice in inoperable and high-risk patients and only recently even revealed favorable outcome in an intermediate risk cohort. Morbidity- and outcome relevant factors like paravalvular aortic regurgitation, vascular access complications and the need for permanent pacemaker implantation remain key challenges during balloon- and self-expandable valve-improvement. Purpose We aimed to address safety and effectiveness between balloon- and self-expandable TAVR devices relating to more than one generation. Methods Patients treated with TAVR between 2009 and 2018 were categorized into either balloon-expandable (BAVR, n=516) or self-expandable (SAVR, n=974) groups. TAVR endpoints and adverse events were defined according to the Valve Academic Research Consortium-2. Primary endpoint was 30-day mortality. Results Logistic EuroSCORE I as predictor for risk stratification and 30-day mortality was comparable between both cohorts (BAVR/SAVR: 25.7%±5.2 vs 25.5%±2.5; p=n.s). Compared to SAVR devices, BAVR devices had significantly higher periprocedural gradients (BAVR/SAVR: 11.7mmHg±0.1 vs 8.3mmHg±0.8; p=0.0175), lower incidence of new renal replacement therapy (BAVR/SAVR: 1.8% vs 4.6%; p=0.0025), and new permanent pacemaker therapy for conduction disturbances (BAVR/SAVR: 8.3% vs 17.3%; p<0.0001), but more frequently disabling bleeding (BAVR/SAVR: 3.9% vs 1.0%; p=0.0003) complications. 30-day mortality was significantly reduced in SAVR-patients (BAVR/SAVR: 4.4% vs 2.4%; p=0.0395). No difference could be observed concerning primary device success (BAVR/SAVR: 1.0%vs 2.0%; p=n.s.), incidence of moderate-to-severe paravalvular leakage (BAVR/SAVR: 3.2% vs 5.0%; p=n.s.), stroke (BAVR/SAVR: 3.3% vs 2.6%; p=n.s.), and major vascular complications (BAVR/SAVR: 2.7% vs 3.5%; p=n.s.). Conclusion Data from the retrospective analysis indicate lower incidence of renal replacement and pacemaker therapy, but higher periprocedural gradients, disabling bleeding complications, and enhanced 30-day mortality for the BAVR device as compared to SAVR. Other issues like paravalvular leackage/aortic regurgitation and stroke still remain unacknowledged.

P3856Timing and associated predictors of onset of new conduction disturbances requiring permanent pacemaker implantation after transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N H M Kooistra ◽  
M S Van Mourik ◽  
R Rodriguez-Olivares ◽  
A H Maass ◽  
V J Nijenhuis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Late Onset ◽  
Pacemaker Implantation ◽  
Early Discharge ◽  
Permanent Pacemaker ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Objectives This study aimed to investigate the onset and the associated predictors of new conduction disturbances (CDs) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI). Background The onset and associated predictors of onset of new CDs leading to PPI are still unknown. However, these are essential for safe and early discharge. Currently, these CDs lead to prolonged post-procedural monitoring after TAVI, limiting early discharge possibilities. Methods We retrospectively analyzed data from five centers in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated to identify the onset of new CD in all patients who required a PPI within 30 days after TAVI. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. Results A total of 2,804 patients were included for analysis. The PPI rate was 11%, of which 18% was due to late onset (>48h) CDs. Independent predictors for late onset CDs requiring PPI were pre-existing non-specific intraventricular conduction delay (IVCD), pre-existing right bundle branch block (RBBB), self-expandable valves, and predilation (Figure). Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours. Figure 1 Conclusions Associated predictors of late onset conduction disturbances leading to PPI after TAVI were pre-existing IVCD, pre-existing RBBB, the use of self-expandable valves, and predilation. Patients without CDs in the first 48 hours after TAVI and without risk factors for late onset CDs requiring PPI are possible candidates for early discharge after 48 hours.

scholarly journals Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Oscar A. Mendiz ◽  
Marko Noč ◽  
Carlos M. Fava ◽  
Luis Abel Gutiérrez Jaikel ◽  
Matias Sztejfman ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Common Complication ◽  
Surgical Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Baseline Characteristics ◽  
Low Volume ◽  
New Onset

Background and Aim. Conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication for TAVR procedures, particularly when self-expanding valves are used. We compared the 30-day incidence of new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPMI) rate between two consecutive groups using either conventional 3-cusp coplanar view (CON) and right/left cusp-overlap view (COVL) for implantation. Methods and Results. We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p = 0.05 ) and PPMI rate (17.8% vs. 6.4%; p = 0.004 ) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). Conclusion. Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.

scholarly journals Permanent Pacemaker Implantation after TAVR – Predictors and Impact on Outcomes

2015 ◽  
Vol 10 (2) ◽  
pp. 98 ◽  
Author(s):  
Weber Marcel ◽  
Sinning Jan-Malte ◽  
Hammerstingl Christoph ◽  
Werner Nikos ◽  
Grube Eberhard ◽  
...  
Keyword(s):  
Heart Valves ◽  
Pacemaker Implantation ◽  
Current Data ◽  
Permanent Pacemaker ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Conduction Abnormalities ◽  
Number Of Patients ◽  
Reported Data ◽  
A Minor

The number of patients undergoing transcatheter aortic valve replacement (TAVR) worldwide is increasing steadily. Atrioventricular conduction disturbances, with or without the need for permanent pacemaker (PPM) implantation, are one of the most common adverse events after TAVR. Among transcatheter heart valves (THV), rates of conduction abnormalities vary from less than 10 % to more than 50 %. Depending on the reported data referred to, historical data showed that up to one-third of the patients required implantation of a PPM following TAVR. Although generally considered as a minor complication, PPM may have a profound impact on prognosis and quality of life after TAVR. Current data support the hypothesis that conduction abnormalities leading to pacemaker dependency result from mechanical compression of the conduction system by the prosthesis stent frame and individual predisposing conduction defects such as right bundle-branch block (RBBB). With several large randomised trials and registry studies having been published recently and second generation THV having been introduced, the debate about predictors for pacemaker implantation and their impact on outcome after TAVR is still ongoing.

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