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Permanent pacemaker implantation after TAVI - Long-term dependency or rhythm recovery?
Session:
Painel 4 -Arritmologia 1
Speaker:
Tânia Proença
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.7 Arrhythmias, General – Other
Session Type:
Posters
FP Number:
---
Authors:
Tânia Proença; Ricardo Alves Pinto; Miguel Martins De Carvalho; Pedro Grilo Diogo; Sofia Torres; Carlos Xavier Resende; Catarina Martins Da Costa; Ana Amador; João Calvão; Alzira Nunes; Paulo Maia Araújo; Roberto Pinto; Marta Tavares Silva; Gonçalo Pestana; Silvia Oliveira; Raquel Mota Garcia; Ana Margarida Lebreiro; Luís Adão; JOAO SILVA; Maria Júlia Maciel Barbosa
Abstract
<p>Introduction: The occurrence of conduction disturbances remains the most frequent complication after transcatheter aortic valve implantation (TAVI). There is a lack of consensus on the management of these conduction disturbances, which has translated into significant differences in permanent pacemaker (PPM) implantation rates between centers.</p> <p>Purpose: To characterize patients who implant PPM after TAVI due to new onset of conduction disturbances.</p> <p>Methods: We retrospectively analyzed consecutive patients who underwent TAVI at a Portuguese tertiary center from October 2014 to November 2019. Clinical and ECG data was collected at presentation and up to 1 year afterwards, including systematic interrogation of implanted PPM at least twice after TAVI.</p> <p>Results: 341 patients without previous PPM underwent TAVI (57% female, mean age 81±8 years). 50% exhibited <em>de novo </em>conduction disturbance. The most frequent disturbance was <em>de novo</em> left bundle branch block (LBBB) (n=109, 32%) and 12.3% of patients (n=42) developed advanced AV block (AVB). Three cases of advanced atrioventricular block (AVB) reverted early during admission (less than 24h) and 56% LBBB reverted up to 6 months. </p> <p>After TAVI, 19% of patients implanted a PPM (n=63), with a median time to implantation of 4 days. The main reason was advanced AVB (64%) followed by LBBB plus 1<sup>st</sup> degree AVB (21%), isolated LBBB (5%) and alternating bundle branch block (ABBB) (5%).</p> <p>At first PPM evaluation, patients with advanced AVB had a median percentage of ventricular pacing (VP) of 78% (43% had VP > 90% and 13% <1%); one year after-TAVI, the median percentage of VP was 83%. Concerning patients with LBBB plus 1<sup>st</sup> degree AVB, median VP at first assessment was 6% (43% of patients had < 1% of VP, while in patients with isolated LBBB or ABBB median VP was 13% and 11% at first evaluation, respectively.</p> <p>Conclusions: LBBB is the most frequent <em>de novo</em> conduction disturbance post-TAVI, with more than half of the cases resolving in the first 6 months. Advanced AVB is the main cause for PPM implantation after TAVI and is associated with a high percentage of ventricular pacing at 1-year follow-up, unlike patients with milder degrees of conduction delay.</p>
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