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Risk factor analysis of permanent pacemaker implantation after transcatheter aortic valve replacement
Session:
Sessão de Posters 23 - Pacing após TAVI
Speaker:
Gonçalo Bettencourt Abreu
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Gonçalo Bettencourt Abreu; Débora Sá; Francisco Sousa; Margarida Temtem; Bruno Silva; Ricardo Rodrigues; Graça Caires; Diogo Rijo; Marco Serrão; Nuno Santos; Flávio Mendonça; António Drumond Freitas
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVR) has been one of the major complications related to this procedure. The need for pacemaker after TAVR occurs in 9 to 26% percent of patients. Taking to account the rapid increase of TAVR procedures and its expansion to younger and lower risk patients, this is a growing problem with elevated clinical and economic burden. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong> Analyze possible risk factors for pacemaker implantation after TAVR. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> 109 consecutive patients (mean age 80,44± 5,77 43,1% male) who underwent TAVR were studied for the need for PPI. Patients were divided into two groups (Group A: PPI; Group B: No PPI). A 12 lead ECG and a computed tomography with aortic calcium score determination was performed in each patient. Bivariate and multivariate analysis evaluated the association between age, gender, QRS width, left bundle branch block (LBBB), right branch block (RBBB), aortic calcification, valve type (self-expandable vs ballon expandable) and valve size with the need for PPI. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 22 patients required PPI (Group A: 20,1%). After bivariate analysis only QRS width (A: Median: 119 ms; B: Median 94 ms) (p=0,013) and RBBB (A: 36%; B:2%) (p <0,0001) were associated with PPI after TVR. After logistic regression only the presence RBBB before TAVR has remained has strong independent risk factor for PPI. </span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> RBBB remains the main risk factor for PPI after TAVR, which is supported by current literature. New preventive strategies are needed to address the high incidence of PPI in this specific subgroup. On the other hand, multiple centers have opted for prophylactic pacemaker implantation in patients with RBBB undergoing TAVR but still with no clear long-term benefit. </span></span></p>
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