Abstract 17215: Pacing Burden in Those Undergoing Permanent Pacemaker Implantation After TAVR With Latest Generation Valves

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Amneet Sandhu ◽  
Karen Ream ◽  
Wendy Tzou ◽  
Alexis Tumolo ◽  
Blake Fleeman ◽  
...  
Keyword(s):  
Heart Valves ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
System Disease ◽  
Edwards Sapien ◽  
Conduction System Disease ◽  
Rv Pacing ◽  
New Generation

Background: Risk factors leading to heart block (HB) and need for permanent pacemaker (PPM) implantation post-TAVR using latest generation heart valves have been described. Yet, little is known regarding pacing burden following PPM implantation among such patients. Objective: We sought to determine follow-up RV pacing burden among those undergoing PPM for HB following TAVR. Methods: From July 2016 to July 2017, we reviewed procedural and 3-month follow-up data (including PPM interrogation data) from all patients undergoing implantation of Edwards Sapien 3® and Medtronic Evolut-R® valves at our institution and requiring implantation of a PPM due to HB secondary to the TAVR procedure. Results: Of 132 included patients who underwent TAVR with new generation valves, 25 (19%) required post-TAVR PPM implantation. Of 25 patients, 18 had available follow-up pacemaker data [Table]. Pacing burden post-PPM implantation of 29mm valves was significantly greater compared to non-29mm valves (40.2% vs. 5.4%, p = 0.02). Those with baseline conduction system disease (RBBB or LBBB) had greater pacing burdens, in particular when 29mm Evolut-R® self-expanding valves were deployed (n=3, RV pacing burden 63.3%). Extension of programmed AV delays produced significant reduction in RV pacing burden. Conclusion: In those undergoing TAVR with latest generation valves complicated by HB requiring PPM use, implantation of larger-sized valves (29 mm Evolut-R® in the present series), as well as baseline RBBB or LBBB results in increased follow-up RV pacing burden. This may be mitigated by adjustment of pacing parameters. Further work investigating long-term pacing burden and its consequences is needed to provide additional insight. Table: Demographics, baseline ECG characteristics, procedural characteristics, pacing mode, pacing parameters and follow-up RV pacing burden.

P3738Clinical outcomes after early vs new generation TAVR device deployment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Kalinczuk ◽  
Z Chmielak ◽  
K Zielinski ◽  
G S Mintz ◽  
M Dabrowski ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pacemaker Implantation ◽  
Real Life ◽  
Permanent Pacemaker ◽  
Early Generation ◽  
Permanent Pacemaker Implantation ◽  
Safety Endpoint ◽  
New Generation

Abstract Background Whether newer generation devices influence early and long-term outcomes post-TAVR in a real life setting is unknown. Aim To assess impact of an early vs a new generation transcatheter heart valves (THV) on clinical outcomes (30-day and -years) in a real life scenario. Methods Out of 445 consecutive pts treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Early generation THV included: CoreValve; Edwards SAPIEN or SAPIEN XT. Newer generation devices included: Evolut-R/-Pro; Acurate neo; Engager, SAPIEN 3; or Lotus Edge Aortic Valve System. Results Median follow-up was 29.3 (15.8–53.1) months with 100% 1-year follow-up. Early generation devices were deployed in 60.6% (n=262) and new devices in 39.4% (n=170). Pts treated with newer devices had more peripheral arterial disease (PAD) and more frequent PCI history (17.1% vs 8.8%, p=0.015, and 35.3% vs 26.7%, p=0.068 respectively); other demographic and clinical data were alike. Baseline aortic valve area and LV ejection fraction were similar between early and newer devices. Pre-dilation was less frequent with newer devices (41.8% vs 70.6%, p<0.001), whereas THV size, contrast volume, fluoroscopy time, radiation dose, and post-procedure aortic valve gradients were similar. Moderate PVL assessed early post-TAVR was recognized with same frequency between earlier vs newer devices (28.2% vs 28.6%). An VARC-2 safety endpoint was recognized more often among pts treated with early vs new devices (30.5% vs 21.8%, p=0.028, respectively), with more frequent: 30-day death (3.8% vs 1.8%, p=0.177), life-threatening or disabling bleeding (8.4% vs 5.3%, p=0.181), major vascular complications (20.2% vs 15.3%, p=0.121), and new permanent pacemaker implantation (22.9% vs 10.0%, p=0.001) with early devices, but similar frequencies of stroke and acute kidney injury (1.9% vs 1.8% and 3.8% vs 5.9%, respectively). The 1-year mortality rates were similar (13.4% vs 13.5%, respectively), with similar estimated midterm (1–2 years) prognosis, but worse estimated very long-term follow-up for newer THV devices (fig 1). Figure 1 Conclusions Newer TAVR devices with smaller delivery system size, although deployed in pts with more PAD and PCI history, are associated with less frequent occurrence of an VARC-2 safety endpoint and less frequent permanent pacemaker implantation. The 1-year and midterm (1–2 years) prognosis are similar for early and newer devices, whereas the longer follow-up could have been influenced by intrinsic pt characteristics (more frequent PAD and history of PCI).

LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING PERMANENT PACEMAKER IMPLANTATION: GATA EXPERIENCE

2015 ◽  
Vol 57 (4) ◽  
pp. 408
Author(s):  
Turgay Celik ◽  
Esra Goktas ◽  
Hasan Kabul ◽  
Sevket Balta ◽  
Atila Iyisoy ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Long Term Follow Up

scholarly journals Conduction disturbances after TAVR: rates of pacemaker implantation, burden of ventricular pacing and prognostic significance

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Bricoli ◽  
G Benatti ◽  
L Vignali ◽  
I Tadonio ◽  
MF Notarangelo ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Ventricular Pacing ◽  
Conduction Disturbances ◽  
Long Term Follow Up ◽  
Rv Pacing ◽  
Complete Av Block

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The occurrence of conduction disturbances remains frequent after TAVR. However, the effect of PM on mortality is controversial and many patients may recover spontaneous AV conduction during follow-up.  PURPOSE To evaluate the incidence of PM implantation after TAVR, PM dependency and  burden of ventricular pacing during follow-up and their influence on mortality.  METHODS AND RESULTS We performed a retrospective analysis of all consecutive 293 patients who underwent TAVR from 2015 to 2019 at our hospital, regional hub for this procedure. Patients were classified into 3 groups: patients without PM (no-PM), patients with a PM implanted prior to TAVR (pre-PM) and patients requiring a PM following TAVR (post-PM) and their clinical and procedural characteristics are listed in Table 1.  The rate of PM implantation after TAVR was 20,8%, at a median of 3.6 days after the procedure. The most common indication was complete AV block. A VVIR pacemaker was implanted in 28 patients, a DDD/DDDR PM in 27 patients and 2 patients received a CRT device. Among post-PPM patients, only 16% were PM-dependent at 2-month and 1-year follow-up. All of them received a PM for complete AV block (AVB). At 1-year follow-up, RV pacing burden was 60% among AVB patients and 23% in patients with a PM implanted for other reasons. PM implantation after TAVR was not associated with a mortality difference at 30-day, 1-year and long-term follow-up. Pre-PPM patients showed a higher mortality rate at long-term follow-up although not statistically significant. CONCLUSIONS Our data suggest that a single chamber device should be preferred in patients implanted for reasons other than complete AVB; in patients with AVB, the use of dual chamber device with an algorithm to minimize RV pacing should be the most suitable choice. Overall (293)No PPM (216)Pre-PPM (19)Post-PPM (57)p-valueAge, median(IQR)82(80-86)82(80-86)82(79-87)82(80-86)0,53Female, n(%)160(55)129(59)6(32)25(44)0,40NYHA III-IV, n(%)191(65)147(68)15(79)29(51)0,06Logistic Euroscore, mean (IQR)7,53(3,5-8,3)7(3,5-8)9,83(3,6-12)6(3,5-7,4)0,51Right bundle-branch block, n(%)21(7)13(6)na8(14)0,04AVA, mean ± SD0,69 ± 0,190,7 ± 0,190,7 ± 0,160,66 ± 0,180,23Self-expandable valve, n(%)181(62)123(57)12(63)46(81)0,001Balloon-expandable valve, n(%)102(35)86(40)7(37)8(14)0,0003Implant depth, mean ± SD6,87 ± 2,96,32 ± 2,65,71 ± 39,12 ± 30,0001Abstract Figure. Kaplan-Meier survival curve

scholarly journals Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259123
Author(s):  
Uwajachukwumma A. Uzomah ◽  
Guy Rozen ◽  
Seyed Mohammadreza Hosseini ◽  
Ayman Shaqdan ◽  
Pablo A. Ledesma ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Cardiac Conduction System ◽  
Permanent Pacemaker Implantation ◽  
System Disease ◽  
Lyme Carditis ◽  
Conduction System Disease

Background Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease. Methods A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality. Results Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05–1.07; P<0.001), complete heart block (OR: 21.5; 95% CI: 12.9–35.7; P<0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7–32.6; P<0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%). Conclusions Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-Up

2009 ◽  
Vol 32 (1) ◽  
pp. 7-12 ◽  
Author(s):  
OFER MERIN ◽  
MICHAEL ILAN ◽  
AVRAHAM OREN ◽  
DANIEL FINK ◽  
MAHER DEEB ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Long Term Follow Up

26 Permanent pacemaker implantation following cardiac surgery: indications and long term follow up

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 5-6
Author(s):  
O. Merin ◽  
M. Ilan ◽  
D. Fink ◽  
A. Oren ◽  
M. Deeb ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Long Term Follow Up

scholarly journals 628 Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve intervention: a systematic review and meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Andrea Zito ◽  
Giuseppe Princi ◽  
Marco Lombardi ◽  
Domenico D’A Mario ◽  
Rocco Vergallo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Aortic Valve ◽  
Meta Analysis ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Clinical Impact ◽  
Transcatheter Aortic Valve

Abstract Aims As compared with surgery, transcatheter aortic valve implantation (TAVI) is associated with increased need for permanent pacemaker implantation (PPMI). The clinical impact of PPMI post-TAVI has not been fully established. To assess by an updated meta-analysis the clinical outcomes related to PPMI after TAVI at long-term (≥12 months) follow-up (LTF). Methods and results A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. A total of 31 studies were identified, providing data on 51 069 patients. The mean duration of follow-up was 22 months. At LTF, PPMI post-TAVI was associated with a higher risk of all-cause death [22.9% vs. 19.6%; risk ratio (RR), 1.18, 95% confidence interval (CI), 1.10–1.25; P &lt; 0.001] and rehospitalization for heart failure (16.6% vs. 15.1%; RR, 1.32; 95% CI, 1.13–1.52; P &lt; 0.001). In contrast, risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported surgical risk, the association between PPMI and LTF all-cause death risk was statistically significant only in studies enrolling patients with high STS-PROM score (RR, 1.25; 95% CI, 1.12–1.40), although there was a similar trend in those at medium and low-risk. Conclusions Patients necessitating PPMI after TAVI have higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPMI. Thus, strategies aimed at reducing need for PPMI might improve survival after TAVI.

Sign in / Sign up

Export Citation Format

Share Document