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Prognostic impact of percentage of ventricular pacing in patients requiring pacemaker implantation after transcatheter aortic valve replacement
Session:
Comunicações Orais (Sessão 8) - Arritmias 2 - Pacing e dispositivos cardíacos
Speaker:
João Pedro Dias Ferreira Reis
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Pedro Reis; Tiago Mendonça; Alexandra Castelo; Inês Rodrigues; António Fiarresga; Ruben Ramos; Mário Oliveira; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Despite the continuous developments of Transcatheter aortic valve implantation (TAVI), around 15% of the patients who undergo this procedure require permanent pacemaker (PPM). Right ventricular pacing (RVP), namely a cumulative percentage of ventricular pacing (CVp) above 40%, has been associated with detrimental effects on ventricular function and an increased risk of events in non-TAVI patients. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To evaluate the long-term prognostic significance of RVP regarding overall mortality and the combined endpoint of overall mortality/ heart failure hospitalization.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We retrospectively examined 517 patients who underwent TAVI with a self-expanding valve from 2009 to 2020 at our institution. All patients had pre-procedural clinical evaluation, cardiac computed tomographic angiography, transthoracic echocardiography and electrocardiography performed. CVp was determined from stored pacemaker data. Patients with previous PPM were excluded. Post-TAVI PPM implantation was defined as a device implantation during hospital stay or during the first month after discharge. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>474 patients, 57% male, mean age 81.7±6.5 years and a mean left ventricular ejection fraction of 51.5±14.6% were analysed. Mean follow-up was 18.7 months. Mean STS score and mean Euroscore II were, respectively, 6.89% and 5.76%. Mean gradient was 51.67 mmHg and mean aortic valve area 0.71 cm<sup>2</sup>. 104 patients (21.9%) required PPM implantation after TAVI, with a mean CVp of 65.3±43.4±. Post-TAVR PPM was not associated with a worse outcome - overall mortality: HR 1.13, 95% CI 0.72 – 1.78, p 0.57; overall mortality/ heart failure hospitalization: HR 1.22, 95% CI 0.87 – 1.70, p 0.24. The follow-up Kaplan-Meier curves according to the need for PPM post-TAVI were similar: log rank p 0.24. A CVp cut-off of 40% was not associated with any of the study endpoints - overall mortality: HR 1.72, 95% CI 0.38 – 7.86, p 0.48; overall mortality/ heart failure hospitalization: HR 1.32, 95% CI 0.45 – 3.91, p 0.61. Also, a CVp cut-off of 40% did not provide an accurate risk stratification as survival free of events was similar between these patients and patients below this cut-off (log rank p 0.11) and in comparison, with patients without PPM (log rank p 0.65). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> In patients submitted to TAVI with a self-expanding valve the need for PPM implantation was not associated with increased risk of total mortality or heart failure hospitalization. A CVp cut-off of 40% showed poor discriminative ability regarding long-term events in this population. </span></span></p>
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