Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis
ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2011-10, Vol.97 (20), p.1687-1694 |
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| creator | Bagur, Rodrigo Manazzoni, Juan Maria Dumont, Éric Doyle, Daniel Perron, Jean Dagenais, François Mathieu, Patrick Baillot, Richard Charbonneau, Éric Metrás, Jacques Mohammadi, Siamak Côté, Mélanie Philippon, François Voisine, Pierre Rodés-Cabau, Josep |
| description | ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.Main outcome measuresThe incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p |
| doi_str_mv | 10.1136/heartjnl-2011-300308 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_894813793</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4020964621</sourcerecordid><originalsourceid>FETCH-LOGICAL-b442t-605d3c4f80087a15e3c8585392c61442307b113763a1807b4e25baad6973e5b13</originalsourceid><addsrcrecordid>eNqNkd1u1DAQhSMEoj_wBghZQoirUDuOE-8lrKCAqlKh5efOmiSTrrdOvNjeLX0JnplZZbdIXCFfeGR_52hmTpY9E_y1ELI6WyKEtBpdXnAhcsm55PpBdizKSu-efjykWiqVV1zWR9lJjCvOeTnT1ePsqBC60EUhjrPfVxgGGHFMbA0tDnCDgdlh7WBMkKwfWe-d87d2vGY2egcJOwY-JNuyLbgtsoAEk3JnYUcGzEG4Rtb6JVHM9wxdh8HdkX-yBEV2a9OSRdxiwINVTDj6aOOT7FEPLuLT_X2afX3_bjH_kF98Pv84f3ORN2VZJJpJdbIte825rkEolK1WWslZ0VaCCMnrhpZUVxKEprrEQjUAXTWrJapGyNPs1eS7Dv7nBmMyg40tOhob_SYaPSs16WeSyBf_kCu_CSM1Z0RN3oKOIqqcqDb4GAP2Zh3sAOHOCG52cZlDXGYXl5niItnzvfmmGbC7Fx3yIeDlHoDYgusDjK2Nf7lSVUWla-LyibO0yV_3_xBuTFXLWpnLb3OjrxaLt18uP5nvxJ9NfDOs_q_VP-p9v-Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1780717175</pqid></control><display><type>article</type><title>Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>PubMed Central</source><creator>Bagur, Rodrigo ; Manazzoni, Juan Maria ; Dumont, Éric ; Doyle, Daniel ; Perron, Jean ; Dagenais, François ; Mathieu, Patrick ; Baillot, Richard ; Charbonneau, Éric ; Metrás, Jacques ; Mohammadi, Siamak ; Côté, Mélanie ; Philippon, François ; Voisine, Pierre ; Rodés-Cabau, Josep</creator><creatorcontrib>Bagur, Rodrigo ; Manazzoni, Juan Maria ; Dumont, Éric ; Doyle, Daniel ; Perron, Jean ; Dagenais, François ; Mathieu, Patrick ; Baillot, Richard ; Charbonneau, Éric ; Metrás, Jacques ; Mohammadi, Siamak ; Côté, Mélanie ; Philippon, François ; Voisine, Pierre ; Rodés-Cabau, Josep</creatorcontrib><description>ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.Main outcome measuresThe incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p=0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p=0.12).ConclusionsThe need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2011-300308</identifier><identifier>PMID: 21828221</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Aged ; Aortic stenosis ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Arrhythmias, Cardiac - epidemiology ; Arrhythmias, Cardiac - etiology ; Arrhythmias, Cardiac - therapy ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiology ; Cardiology. Vascular system ; coronary intervention (PCI) ; elderly ; Electrocardiography ; Electrodes, Implanted ; Endocardial and cardiac valvular diseases ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Heart surgery ; Heart Valve Prosthesis - adverse effects ; Hospitals ; Humans ; Incidence ; interventional cardiology ; Male ; Medical sciences ; Mortality ; pacemaker implantation ; Pacemaker, Artificial ; percutaneous valve therapy ; Population ; Quebec - epidemiology ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Studies ; Survival Rate - trends ; Time Factors ; transcatheter ; Treatment Outcome ; valve replacement ; Variables</subject><ispartof>Heart (British Cardiac Society), 2011-10, Vol.97 (20), p.1687-1694</ispartof><rights>2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2011 (c) 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b442t-605d3c4f80087a15e3c8585392c61442307b113763a1807b4e25baad6973e5b13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://heart.bmj.com/content/97/20/1687.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://heart.bmj.com/content/97/20/1687.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24562687$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21828221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bagur, Rodrigo</creatorcontrib><creatorcontrib>Manazzoni, Juan Maria</creatorcontrib><creatorcontrib>Dumont, Éric</creatorcontrib><creatorcontrib>Doyle, Daniel</creatorcontrib><creatorcontrib>Perron, Jean</creatorcontrib><creatorcontrib>Dagenais, François</creatorcontrib><creatorcontrib>Mathieu, Patrick</creatorcontrib><creatorcontrib>Baillot, Richard</creatorcontrib><creatorcontrib>Charbonneau, Éric</creatorcontrib><creatorcontrib>Metrás, Jacques</creatorcontrib><creatorcontrib>Mohammadi, Siamak</creatorcontrib><creatorcontrib>Côté, Mélanie</creatorcontrib><creatorcontrib>Philippon, François</creatorcontrib><creatorcontrib>Voisine, Pierre</creatorcontrib><creatorcontrib>Rodés-Cabau, Josep</creatorcontrib><title>Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.Main outcome measuresThe incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p=0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p=0.12).ConclusionsThe need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.</description><subject>Aged</subject><subject>Aortic stenosis</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Arrhythmias, Cardiac - epidemiology</subject><subject>Arrhythmias, Cardiac - etiology</subject><subject>Arrhythmias, Cardiac - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>coronary intervention (PCI)</subject><subject>elderly</subject><subject>Electrocardiography</subject><subject>Electrodes, Implanted</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Heart Valve Prosthesis - adverse effects</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>interventional cardiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>pacemaker implantation</subject><subject>Pacemaker, Artificial</subject><subject>percutaneous valve therapy</subject><subject>Population</subject><subject>Quebec - epidemiology</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><subject>transcatheter</subject><subject>Treatment Outcome</subject><subject>valve replacement</subject><subject>Variables</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkd1u1DAQhSMEoj_wBghZQoirUDuOE-8lrKCAqlKh5efOmiSTrrdOvNjeLX0JnplZZbdIXCFfeGR_52hmTpY9E_y1ELI6WyKEtBpdXnAhcsm55PpBdizKSu-efjykWiqVV1zWR9lJjCvOeTnT1ePsqBC60EUhjrPfVxgGGHFMbA0tDnCDgdlh7WBMkKwfWe-d87d2vGY2egcJOwY-JNuyLbgtsoAEk3JnYUcGzEG4Rtb6JVHM9wxdh8HdkX-yBEV2a9OSRdxiwINVTDj6aOOT7FEPLuLT_X2afX3_bjH_kF98Pv84f3ORN2VZJJpJdbIte825rkEolK1WWslZ0VaCCMnrhpZUVxKEprrEQjUAXTWrJapGyNPs1eS7Dv7nBmMyg40tOhob_SYaPSs16WeSyBf_kCu_CSM1Z0RN3oKOIqqcqDb4GAP2Zh3sAOHOCG52cZlDXGYXl5niItnzvfmmGbC7Fx3yIeDlHoDYgusDjK2Nf7lSVUWla-LyibO0yV_3_xBuTFXLWpnLb3OjrxaLt18uP5nvxJ9NfDOs_q_VP-p9v-Q</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Bagur, Rodrigo</creator><creator>Manazzoni, Juan Maria</creator><creator>Dumont, Éric</creator><creator>Doyle, Daniel</creator><creator>Perron, Jean</creator><creator>Dagenais, François</creator><creator>Mathieu, Patrick</creator><creator>Baillot, Richard</creator><creator>Charbonneau, Éric</creator><creator>Metrás, Jacques</creator><creator>Mohammadi, Siamak</creator><creator>Côté, Mélanie</creator><creator>Philippon, François</creator><creator>Voisine, Pierre</creator><creator>Rodés-Cabau, Josep</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis</title><author>Bagur, Rodrigo ; Manazzoni, Juan Maria ; Dumont, Éric ; Doyle, Daniel ; Perron, Jean ; Dagenais, François ; Mathieu, Patrick ; Baillot, Richard ; Charbonneau, Éric ; Metrás, Jacques ; Mohammadi, Siamak ; Côté, Mélanie ; Philippon, François ; Voisine, Pierre ; Rodés-Cabau, Josep</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b442t-605d3c4f80087a15e3c8585392c61442307b113763a1807b4e25baad6973e5b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aortic stenosis</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Arrhythmias, Cardiac - epidemiology</topic><topic>Arrhythmias, Cardiac - etiology</topic><topic>Arrhythmias, Cardiac - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>coronary intervention (PCI)</topic><topic>elderly</topic><topic>Electrocardiography</topic><topic>Electrodes, Implanted</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart surgery</topic><topic>Heart Valve Prosthesis - adverse effects</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>interventional cardiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>pacemaker implantation</topic><topic>Pacemaker, Artificial</topic><topic>percutaneous valve therapy</topic><topic>Population</topic><topic>Quebec - epidemiology</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><topic>transcatheter</topic><topic>Treatment Outcome</topic><topic>valve replacement</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bagur, Rodrigo</creatorcontrib><creatorcontrib>Manazzoni, Juan Maria</creatorcontrib><creatorcontrib>Dumont, Éric</creatorcontrib><creatorcontrib>Doyle, Daniel</creatorcontrib><creatorcontrib>Perron, Jean</creatorcontrib><creatorcontrib>Dagenais, François</creatorcontrib><creatorcontrib>Mathieu, Patrick</creatorcontrib><creatorcontrib>Baillot, Richard</creatorcontrib><creatorcontrib>Charbonneau, Éric</creatorcontrib><creatorcontrib>Metrás, Jacques</creatorcontrib><creatorcontrib>Mohammadi, Siamak</creatorcontrib><creatorcontrib>Côté, Mélanie</creatorcontrib><creatorcontrib>Philippon, François</creatorcontrib><creatorcontrib>Voisine, Pierre</creatorcontrib><creatorcontrib>Rodés-Cabau, Josep</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bagur, Rodrigo</au><au>Manazzoni, Juan Maria</au><au>Dumont, Éric</au><au>Doyle, Daniel</au><au>Perron, Jean</au><au>Dagenais, François</au><au>Mathieu, Patrick</au><au>Baillot, Richard</au><au>Charbonneau, Éric</au><au>Metrás, Jacques</au><au>Mohammadi, Siamak</au><au>Côté, Mélanie</au><au>Philippon, François</au><au>Voisine, Pierre</au><au>Rodés-Cabau, Josep</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>97</volume><issue>20</issue><spage>1687</spage><epage>1694</epage><pages>1687-1694</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.Main outcome measuresThe incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p=0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p=0.12).ConclusionsThe need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>21828221</pmid><doi>10.1136/heartjnl-2011-300308</doi><tpages>8</tpages></addata></record> |
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| ispartof | Heart (British Cardiac Society), 2011-10, Vol.97 (20), p.1687-1694 |
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| subjects | Aged Aortic stenosis Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Arrhythmias, Cardiac - epidemiology Arrhythmias, Cardiac - etiology Arrhythmias, Cardiac - therapy Biological and medical sciences Cardiac arrhythmia Cardiology Cardiology. Vascular system coronary intervention (PCI) elderly Electrocardiography Electrodes, Implanted Endocardial and cardiac valvular diseases Female Follow-Up Studies Heart Heart attacks Heart surgery Heart Valve Prosthesis - adverse effects Hospitals Humans Incidence interventional cardiology Male Medical sciences Mortality pacemaker implantation Pacemaker, Artificial percutaneous valve therapy Population Quebec - epidemiology Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Risk Factors Severity of Illness Index Studies Survival Rate - trends Time Factors transcatheter Treatment Outcome valve replacement Variables |
| title | Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis |
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