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Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis
Univ Hosp Tubingen, Germany.
Cologne Univ, Germany; Heart and Diabet Ctr NRW, Germany.
Univ Amsterdam, Netherlands.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
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2020 (English)In: Heart and Vessels, ISSN 0910-8327, E-ISSN 1615-2573, Vol. 35, p. 1735-1745Article in journal (Refereed) Published
Abstract [en]

Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01-2.59), QRS duration > 117 ms (OR 2.58; 95% CI 1.73-3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39-7.72), left anterior hemi block (OR 1.92; 95% CI 1.19-3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05-2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19-21.86) and first-degree AVB (OR 2.39; 95% CI 1.18-4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07-4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35-2.59), mean TAVI valve implantation depth below the annulus > 30% (OR 3.75; 95% CI 2.01-6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%;p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes. Clinical Trial: NCT03497611.

Place, publisher, year, edition, pages
Springer, 2020. Vol. 35, p. 1735-1745
Keywords [en]
Aortic stenosis; Transcatheter aortic valve implantation; Pacemaker
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-167734DOI: 10.1007/s00380-020-01653-6ISI: 000543606000002PubMedID: 32591894Scopus ID: 2-s2.0-85087015040OAI: oai:DiVA.org:liu-167734DiVA, id: diva2:1454950
Note

Funding Agencies|Edwards Lifesciences (Nyon, Switzerland)

Available from: 2020-07-21 Created: 2020-07-21 Last updated: 2021-04-30Bibliographically approved

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Nielsen, Niels Erik

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Nielsen, Niels ErikBaranowski, Jacek
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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDepartment of Cardiology in Linköping
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Heart and Vessels
Surgery

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