Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation
Background Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and...
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| Veröffentlicht in: | The American heart journal 2012-03, Vol.163 (3), p.492-499 |
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| creator | De Carlo, Marco, MD, PhD Giannini, Cristina, MD Bedogni, Francesco, MD Klugmann, Silvio, MD Brambilla, Nedy, MD De Marco, Federico, MD Zucchelli, Giulio, MD Testa, Luca, MD Oreglia, Jacopo, MD Petronio, Anna Sonia, MD |
| description | Background Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. Methods We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Results Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction |
| doi_str_mv | 10.1016/j.ahj.2011.12.009 |
| format | Article |
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Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. Methods We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Results Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM ( P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB ( P = .37). Conclusion A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2011.12.009</identifier><identifier>PMID: 22424022</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - surgery ; Atrioventricular Block - etiology ; Atrioventricular Block - physiopathology ; Atrioventricular Block - therapy ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac Catheterization ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Electrocardiography ; Female ; Follow-Up Studies ; Heart attacks ; Heart Conduction System - physiopathology ; Heart Rate ; Heart Valve Prosthesis Implantation - methods ; Hospitalization ; Humans ; Logistics ; Male ; Medical sciences ; Pacemaker, Artificial - standards ; Patients ; Postoperative Complications - prevention & control ; Practice Guidelines as Topic - standards ; Prospective Studies ; Prostheses ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Software ; Treatment Outcome</subject><ispartof>The American heart journal, 2012-03, Vol.163 (3), p.492-499</ispartof><rights>Mosby, Inc.</rights><rights>2012 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c531t-109ff32c76179045c8340d3ffa55d97fa1b90ec5c363cba821bdb9b17e9ebb273</citedby><cites>FETCH-LOGICAL-c531t-109ff32c76179045c8340d3ffa55d97fa1b90ec5c363cba821bdb9b17e9ebb273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870311008908$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25963737$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22424022$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Carlo, Marco, MD, PhD</creatorcontrib><creatorcontrib>Giannini, Cristina, MD</creatorcontrib><creatorcontrib>Bedogni, Francesco, MD</creatorcontrib><creatorcontrib>Klugmann, Silvio, MD</creatorcontrib><creatorcontrib>Brambilla, Nedy, MD</creatorcontrib><creatorcontrib>De Marco, Federico, MD</creatorcontrib><creatorcontrib>Zucchelli, Giulio, MD</creatorcontrib><creatorcontrib>Testa, Luca, MD</creatorcontrib><creatorcontrib>Oreglia, Jacopo, MD</creatorcontrib><creatorcontrib>Petronio, Anna Sonia, MD</creatorcontrib><title>Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. Methods We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Results Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM ( P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB ( P = .37). Conclusion A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.</description><subject>Aged</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Atrioventricular Block - etiology</subject><subject>Atrioventricular Block - physiopathology</subject><subject>Atrioventricular Block - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Catheterization</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Rate</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Logistics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pacemaker, Artificial - standards</subject><subject>Patients</subject><subject>Postoperative Complications - prevention & control</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Prospective Studies</subject><subject>Prostheses</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. 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Vascular system</topic><topic>Cardiovascular</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Rate</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Logistics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pacemaker, Artificial - standards</topic><topic>Patients</topic><topic>Postoperative Complications - prevention & control</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Prospective Studies</topic><topic>Prostheses</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. 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Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. Methods We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Results Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM ( P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB ( P = .37). Conclusion A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22424022</pmid><doi>10.1016/j.ahj.2011.12.009</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - surgery Atrioventricular Block - etiology Atrioventricular Block - physiopathology Atrioventricular Block - therapy Biological and medical sciences Cardiac arrhythmia Cardiac Catheterization Cardiology Cardiology. Vascular system Cardiovascular Electrocardiography Female Follow-Up Studies Heart attacks Heart Conduction System - physiopathology Heart Rate Heart Valve Prosthesis Implantation - methods Hospitalization Humans Logistics Male Medical sciences Pacemaker, Artificial - standards Patients Postoperative Complications - prevention & control Practice Guidelines as Topic - standards Prospective Studies Prostheses Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Software Treatment Outcome |
| title | Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation |
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