Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function

Transcatheter aortic valve implantation (TAVI) is a well-established procedure; however, atrioventricular block requiring permanent pacemaker implantation (PPI) is a common complication. To determine the incidence, predictors and clinical outcomes of PPI after TAVI, focusing on how PPI affects left...

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Published in:	Arquivos brasileiros de cardiologia Vol. 109; no. 6; pp. 550 - 559
Main Authors:	Monteiro, Cláudio, Ferrari, Andres Di Leoni, Caramori, Paulo Ricardo Avancini, Carvalho, Luiz Antonio Ferreira, Siqueira, Dimytri Alexandre de Alvim, Thiago, Luiz Eduardo Koenig São, Perin, Marco, Lima, Valter C de, Guérios, Enio, Brito Junior, Fabio Sandoli De
Format:	Journal Article
Language:	English
Published:	Brazil Sociedade Brasileira de Cardiologia - SBC 01-12-2017 Sociedade Brasileira de Cardiologia (SBC)
Subjects:	Bloqueio Atrioventricular CARDIAC & CARDIOVASCULAR SYSTEMS Estenose Aórtica Marca-Passo Artificial Original Substituição da Valva Aórtica Transcateter / complicações Volume Sistólico Volume Sistólico Stroke Volume Substituição da Valva Aórtica Transcateter / complicações Atroventricular Block Transcatheter Aortic Valve Replacement / complications Aortic Valve Stenosis Estenose Aórtica Bloqueio Atrioventricular Marca-Passo Artificial Pacemaker, Artificial
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Summary:	Transcatheter aortic valve implantation (TAVI) is a well-established procedure; however, atrioventricular block requiring permanent pacemaker implantation (PPI) is a common complication. To determine the incidence, predictors and clinical outcomes of PPI after TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF) after TAVI. The Brazilian Multicenter TAVI Registry included 819 patients submitted to TAVI due to severe aortic stenosis from 22 centers from January/2008 to January/2015. After exclusions, the predictors of PPI were assessed in 670 patients by use of multivariate regression. Analysis of the ROC curve was used to measure the ability of the predictors; p < 0.05 was the significance level adopted. Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex (59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p < 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p = 0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of multivariate analysis, the previous presence of right bundle-branch block (RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤ 0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2; p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%, when none of those predictors was present, to 63%, in the presence of all of them. The model showed good ability to predict the need for PPI: 0.69 (95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms during the 1-year follow-up showed worse LVEF course in patients submitted to PPI (p = 0.01). BRD prévio, gradiente aórtico médio > 50 mmHg e CoreValve® são preditores independentes de implante de MPD pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de TAVI, o que prolongou a internação hospitalar, mas não afetou a mortalidade. O implante de MPD afetou negativamente a FEVE pós-TAVI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0066-782X 1678-4170 1678-4170
DOI:	10.5935/abc.20170170