Anatomical predictors of high grade atrioventricular conduction disorders in patients with specific pacemaker implanted after TAVI

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Frey ◽  
A Brochier ◽  
N Nezzouhairi ◽  
D Irles
Keyword(s):  
Atrioventricular Block ◽  
Pacemaker Implantation ◽  
Atrioventricular Conduction ◽  
High Grade ◽  
Av Block ◽  
Conduction Disorders ◽  
Transcatheter Aortic Valve ◽  
The Difference ◽  
Valve Implantation ◽  
Membranous Septum

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf STIM TAVI-MS study Background  The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. Recent studies have identified short membranous septum (MS) length, deep implantation depth (ID) or their relation as anatomic risk of high-grade AV block and permanent pacemaker implantation. Purpose : We sought to examine whether the atrioventricular (AV) membranous septum (MS) measured by computed tomography (CT) and the depth of valve implantation measured from the final aortic angiogram could predict high-grade atrioventricular block (HG AVB) after TAVI, based on specific pacemaker memory data. Methods STIM-TAVI-MS was a prospective, multicentre observational study that enrolled patients implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of late (after Day 7) high-grade atrioventricular block(s) during the year after TAVI. We measured on CT scans the coronal MS lenght, infra-annular MS lenght and the quantification of calcifications, on the final angiogram after TAVI we measured the implant depth (ID) to identifie ΔID-MS corresponding to the difference between implant depth and MS length. The variables were compared with the occurrence of late HG-AVB on PM memory data. Results : Among 82 patients, (mean age 84,5 years ± 4,8, self-expending valve n = 24, 29,3%), n = 47 (57.3%) had ≥1 late high-grade atrioventricular block. Mean coronal MS length was 8,1 ± 2,5 mm, mean infra annular MS was 3,4 ± 3.1 mm, mean calcification volume was 93.0 ± 88, 85,5± 104 and 141,5 ± 137,5 mm3 for the noncoronary, right coronary and left coronary cusp respectively. Mean implant depth was 7,3 ± 3,3mm, and mean ΔID-MS = -0,7 ± 4,1mm. There were no association between MS length (OR = 1,06; CI 0,91 to 1,24), ID (OR = 1,6; CI 0,85 to 2,9), nor ΔID-MS (OR = 0,67; CI 0,37 to 1,23) and late HG AVB. Calcification volume were not associated with late HG AVB. Conclusion In an high risk high grade AV block population after TAVI, anatomical analysis of MS length, degree of calcification, implant depth and ΔID-MS did not predict occurrence of late (> day 7 after TAVI ) high grade AV Blocks. Abstract Figure. CT scan A : aortic plane, B : MS lenght

Abstract 15952: Feasibility and Safety of Balloon Expandable Transcatheter Aortic Valve Implantation With Moderate or No Predilatation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yigal Abramowitz ◽  
Hasan Jilaihawi ◽  
Tarun Chakravarty ◽  
Mamoo Nakamura ◽  
Wen Cheng ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Limited Data ◽  
Balloon Aortic Valvuloplasty ◽  
Transfemoral Approach ◽  
Conduction Disorders ◽  
Transcatheter Aortic Valve ◽  
Procedural Success ◽  
Valve Implantation

Background: Aortic valve preparation by performing balloon aortic valvuloplasty (BAV) has so far been considered mandatory during transcatheter aortic valve replacement (TAVR) procedures. We hypothesized that performing TAVR without predilatation (PD) could potentially reduce BAV complications during TAVR (e.g. stroke or conduction disorders), while yielding similar hemodynamic and clinical outcome. There is limited data on the safety of TAVR with moderate or with no PD and previous publications addressing this issue are mainly of self-expandable valves. Methods & Results: Between September 2012 and January 2014, 95 patients underwent direct balloon expandable TAVR (no PD group) and 255 patients had moderate PD before valve deployment (mean balloon width-15mm; moderate PD group). The Transfemoral approach was used in 79% of patients. Device success was similar between groups (no PD -97%, moderate PD -95%; p=0.44), post procedural mean aortic valve gradients were 6.8 and 6mmHG. There was significantly less initial perivalvular leak (PVL) in the no PD group: 82%, 17%, 1%, 0% versus 66%, 23%, 9%, 2% for no/trace, mild, moderate and severe PVL respectively (p<0.01). Postdilatation was performed in 5.3% of the patients in the no PD group compared to 8.2% in the moderate PD group (p=0.34). Thirty-day mortality and stroke rates were 2.1% and 2.1% in the no PD group compared to 3.5 and 2.4 in the moderate PD group (Table). Fewer permanent pacemaker implantations were needed in the no PD group (2.1% vs. 7.8%; p=0.048). All other in-hospital complications were similar between groups. Conclusions: TAVR with moderate or no PD is feasible and safe. The no PD approach was associated with lower rates of permanent pacemaker implantation and less PVL without affecting procedural success.

Need for pacemaker implantation in patients with normal QRS duration immediately after transcatheter aortic valve implantation

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1851-1856 ◽  
Author(s):  
Simon Schoechlin ◽  
Fares Jalil ◽  
Thomas Blum ◽  
Philipp Ruile ◽  
Manuel Hein ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Transcatheter Aortic Valve ◽  
Qrs Duration ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Complete Av Block

Abstract Aims We sought to assess the need for permanent pacemaker implantation (PPI) in patients with QRS <120 ms in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI). Methods and results We retrospectively analysed 1139 consecutive patients who underwent transfemoral TAVI between 2008 and 2016, receiving different valve types. All patients were surveyed by continuous ECG monitoring for 48 h, 12-lead ECGs starting immediately after procedure, as well as 24-h Holter recording the day before discharge. Indication for PPI was at the discretion of the attending physician. Among 760 patients with QRS <120 ms prior to the TAVI procedure, 400 patients showed QRS <120 ms immediately after procedure, whereas 360 patients had QRS ≥120 ms. In the group with QRS <120 ms, PPI was performed in 34 patients [8.5%; 95% confidence interval (CI) 5.6–11.2%] during the first week. Eight of the PPIs in the group with QRS <120 ms (2%; CI 0.8–3.5%) fulfilled Class I indications for PPI after TAVI, whereas 26 PPIs had different indications [left bundle branch block, sick sinus, low-grade atrioventricular (AV) block]. Complete AV block developed in three patients of the group of QRS <120 ms (0.75%; CI 0.0–1.7%), which in all cases occurred after the 48 h-surveillance period. During 1-year follow-up, 11 PPIs were performed (2.8%; CI 1.2–4.5%), thereof three PPI for Class I indications including one complete AV block. Conclusion In patients with QRS duration <120 ms immediately after TAVI, the risk for complete AV block was low during the first week after TAVI and 1-year follow-up.

Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve implantation: a meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Maier ◽  
T Zeus ◽  
C Jung ◽  
R Westenfeld ◽  
A Polzin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Meta Analysis ◽  
Av Block ◽  
Transcatheter Aortic Valve ◽  
Implantation Depth ◽  
Aortic Valve Implantation ◽  
Coronary Cusp ◽  
Valve Implantation ◽  
New Generation ◽  
Membranous Septum

Abstract Background Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. Unfortunately, the occurrence of electrical conduction disturbances remains one of the most frequent complications of the procedure. While the impact of electrocardiographic and procedural predictors on PPI is well examined, there is still a lack of knowledge regarding anatomical predictors screened by multislice computed tomography (MSCT). Purpose We performed a meta-analysis to summarize available studies that reported the incidence of PPI after TAVI with new-generation devices and provided raw data for preprocedural MSCT. Methods The authors conducted a literature search in PubMed database until December 31, 2019 to identify studies that investigated preprocedural MSCT data and rate of PPI following TAVI with new-generation devices. Twelve observational studies (n=3133) met inclusion criteria for final analysis. Results PPI was performed in 509 patients (16.2%) after TAVI, mostly due to high degree atrioventricular (AV) block (80.8%). The rate of PPI varied widely from 7.9% to 35.8% in individual studies. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) electrocardiographic PPI-predictors after TAVI appeared to be pre-existing atrial fibrillation (AF) (RR 1.21; 95% CI 1.05–1.40; p=0.008), right bundle branch block (RBBB) (RR 4.22; 95% CI 3.30–5.41; p&lt;0.0001) and AV block grade I (RR 1.63; 95% CI 1.16–2.29; p=0.005). Patients requiring PPI had larger annulus perimeter (MD 1.66 mm; 95% CI 0.67–2.66 mm; p=0.001) and shorter membranous septum length (MD −0.86 mm; 95% CI −1.74–0.02 mm; p=0.05) assessed by preprocedural MSCT. Concerning calcium load of device landing zone, pacemaker dependent patients showed increased calcification of the non-coronary cusp (MD 39.76 mm3; 95% CI 18.60–60.93 mm3; p=0.0002), the left-coronary cusp (LCC) (MD 47.60 mm3; 95% CI 19.40–75.81 mm3; p=0.0009) and the total left ventricular outflow tract (LVOT) (MD 19.17 mm3; 95% CI 6.68–31.66 mm3; p=0.003). Lower implantation depth (MD 0.83 mm from NCC; 95% CI 0.20–1.47 mm; p=0.01) and oversizing by annulus diameter/area (MD 1.76%; 95% CI 0.68–2.84%; p=0.001) were procedural predictors of PPI following TAVI. Conclusion This structured meta-analysis proved PPI rate in 16.2% of patients following TAVI. Beside well-known electrocardiographic (AF, RBBB, AV block grade I) and procedural predictors (implantation depth, oversizing) this meta-analysis showed for the first time that MSCT derived anatomical values (annulus perimeter, membranous septum length) and distribution of device landing zone's calcification (NCC, LCC, LVOT) are associated with increased risk of PPI following TAVI. Funding Acknowledgement Type of funding source: None

Abstract 4514: Postoperative AV Block and Pacemaker Implantation after Transcatheter Aortic Valve Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sabine Bleiziffer ◽  
Hendrik Ruge ◽  
Jurgen Horer ◽  
Domenico Mazzitelli ◽  
Christian Schreiber ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Logistic Regression Analysis ◽  
High Grade ◽  
Av Block ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

High grade AV block and consecutive pacemaker (PM) implantation are frequent complications following transcatheter aortic valve implantation (TAVI). We aimed to identify risk factors predicting these complications. For logistic regression analysis, we included 85 patients (mean age 81±7y, EuroScore 24±15%) who underwent TAVI (n=73 transfemoral, n=2 via subclavian artery, n=10 transapical) between June 2007 and May 2008 and who had no previously implanted PM. Of those, 22 (26%) developed postoperative AV block with the need of PM implantation. PM implantation had to be performed more frequently in patients with pathological preoperative ECG findings, such as AV block °I (33% PM implantation) or bundle branch block (39% PM implantation) vs normal ECG (20% PM implantation, n.s.), and in patients receiving a CoreValve (28% PM implantation) vs an Edwards Sapien prosthesis (10% PM implantation, n.s.). Stepwise logistic regression analysis revealed the occurrence of a transient AV block > °I during the TAVI procedure (52% PM implantation) as the only significant independent factor predicting later PM implantation (OR 8.98, CI 2.69 –29.98, p<0.001), while gender, age, EuroScore, prosthesis type and dimensions, annulus diameter and preoperative ECG findings had no significant influence. Patients who experience a transient AV block > °I during TAVI procedures should carefully be monitored postoperatively, as there is a 9fold increased risk of developing high grade AV block with the indication for a PM implantation.

Low pacemaker incidence with continuous-sutured valves: a retrospective analysis

2017 ◽  
Vol 25 (5) ◽  
pp. 350-356 ◽  
Author(s):  
Lars Niclauss ◽  
Dominique Delay ◽  
Raymond Pfister ◽  
Sebastien Colombier ◽  
Matthias Kirsch ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Suture Technique ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Conduction Disorders ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background Permanent pacemaker implantation after surgical aortic valve replacement depends on patient selection and risk factors for conduction disorders. We aimed to identify risk criteria and obtain a selected group comparable to patients assigned to transcatheter aortic valve implantation. Methods Isolated sutured aortic valve replacements in 994 patients treated from 2007 to 2015 were reviewed. Demographics, hospital stay, preexisting conduction disorders, surgical technique, and etiology in patients with and without permanent pacemaker implantation were compared. Reported outcomes after transcatheter aortic valve implantation were compared with those of a subgroup including only degenerative valve disease and first redo. Results The incidence of permanent pacemaker implantation was 2.9%. Longer hospital stay ( p = 0.01), preexisting rhythm disorders ( p < 0.001), complex prosthetic endocarditis ( p = 0.01), and complex redo ( p < 0.001) were associated with permanent pacemaker implantation. Although prostheses were sutured with continuous monofilament in the majority of cases (86%), interrupted pledgetted sutures were used more often in the pacemaker group ( p = 0.002). In the subgroup analysis, the incidence of permanent pacemaker implantation was 2%; preexisting rhythm disorders and the suture technique were still major risk factors. Conclusion Permanent pacemaker implantation depends on etiology, preexisting rhythm disorders, and suture technique, and the 2% incidence compares favorably with the reported 5- to 10-fold higher incidence after transcatheter aortic valve implantation. Cost analysis should take this into account. Often dismissed as minor complication, permanent pacemaker implantation increases the risks of endocarditis, impaired myocardial recovery, and higher mortality if associated with prosthesis regurgitation.

scholarly journals Epicardial fat volume is associated with preexisting atrioventricular conduction abnormalities and increased pacemaker implantation rate in patients undergoing transcatheter aortic valve implantation

2021 ◽  
Author(s):  
Maren Weferling ◽  
Andreas Rolf ◽  
Ulrich Fischer-Rasokat ◽  
Christoph Liebetrau ◽  
Matthias Renker ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Epicardial Fat ◽  
Agatston Score ◽  
Av Block ◽  
Bundle Branch Block ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

AbstractEpicardial fat tissue (EFT) is a highly metabolically active fat depot surrounding the heart and coronary arteries that is related to early atherosclerosis and adverse cardiac events. We aimed to investigate the relationship between the amount of EFT and preexisting cardiac conduction abnormalities (CCAs) and the need for new postinterventional pacemaker in patients with severe aortic stenosis planned for transcatheter aortic valve implantation (TAVI). A total of 560 consecutive patients (54% female) scheduled for TAVI were included in this retrospective study. EFT volume was measured via a fully automated artificial intelligence software (QFAT) using computed tomography (CT) performed before TAVI. Baseline CCAs [first-degree atrioventricular (AV) block, right bundle branch block (RBBB), and left bundle branch block (LBBB)] were diagnosed according to 12-lead ECG before TAVI. Aortic valve calcification was determined by the Agatston score assessed in the pre-TAVI CT. The median EFT volume was 129.5 ml [IQR 94–170]. Baseline first-degree AV block was present in 17%, RBBB in 10.4%, and LBBB in 10.2% of the overall cohort. In adjusted logistic regression analysis, higher EFT volume was associated with first-degree AV block (OR 1.006 [95% CI 1.002–1.010]; p = 0.006) and the need for new pacemaker implantation after TAVI (OR 1.005 [95% CI 1.0–1.01]; p = 0.035) but not with the presence of RBBB or LBBB. EFT volume did not correlate with the Agatston score of the aortic valve. Greater EFT volume is associated independently with preexisting first-degree AV block and new pacemaker implantation in patients undergoing TAVI. It may play a causative role in degenerative processes and the susceptibility of the AV conduction system.

scholarly journals The ACURATE neo2 valve system for transcatheter aortic valve implantation: 30-day and 1-year outcomes

2021 ◽  
Author(s):  
Helge Möllmann ◽  
David M. Holzhey ◽  
Michael Hilker ◽  
Stefan Toggweiler ◽  
Ulrich Schäfer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Valve Thrombosis ◽  
Aortic Valve Implantation ◽  
And Performance ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has become standard treatment for elderly patients with symptomatic severe aortic valve stenosis. The ACURATE neo AS study evaluates 30-day and 1-year clinical and hemodynamic outcomes in patients treated with the ACURATE neo2 valve. Methods The primary endpoint of this single-arm multicenter study is 30-day all-cause mortality. Other key endpoints include device performance, echocardiographic measures assessed by an independent core laboratory, and VARC-2 clinical efficacy and safety endpoints through 12 months. Results The study enrolled 120 patients (mean age 82.1 ± 4.0 years; 67.5% female, mean baseline STS score 4.8 ± 3.8%). The VARC-2 composite safety endpoint at 30 days occurred in 13.3% of patients. All-cause mortality was 3.3% at 30 days and 11.9% at 1 year. The 30-day stroke rate was 2.5% (disabling stroke 1.7%); there were no new strokes between 30 days and 12 months. The rate of permanent pacemaker implantation was 15.0% (18/120) at 30 days and 17.8% (21/120) at 1 year. No patients required re-intervention for valve-related dysfunction and there were no cases of valve thrombosis or endocarditis. Patients demonstrated significant improvement in mean aortic valve gradient (baseline 38.9 ± 13.1 mmHg, 1 year 7.8 ± 3.5 mmHg; P < 0.001 in a paired analysis). In the overall population, paravalvular leak was evaluated at 1 year as none/trace in 60.5%, mild in 37.0%, and moderate in 2.5%; no patients had severe PVL. Conclusions One-year outcomes from the ACURATE neo AS study support the safety and performance of TAVI with the ACURATE neo2 valve. Graphic Abstract

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