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Impact of Rhytm Disturbances in Patients with Left Ventricular Dysfunction Undergoing TAVI
Session:
Sessão de Posters 23 - Pacing após TAVI
Speaker:
André Lobo
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:
Andre Lobo; Rafael Teixeira; Marta Catarina Almeida; Inês Neves; Marta Leite; Fábio Nunes; Inês Rodrigues; António Gonçalves; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Transaortic Valve Implantation (TAVI) has demonstrated significant benefits in patients with severe aortic stenosis and left ventricular dysfunction. However, the concurrent presence of bundle branch block (BBB) or pacemaker (PM) is associated with a potential decrease in left ventricular ejection fraction (LVEF), and the occurrence of rhythm disturbances is prevalent in the TAVI context.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aims: Evaluate the influence of pre-existing and newly developed Left Bundle Branch Block (LBBB), Right Bundle Branch Block (RBBB) or PM implantation on LVEF progression and overall survival in patients undergoing TAVI with reduced LVEF (<50%). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Single-center retrospective cohort analysis including patients with reduced LVEF undergoing TAVI from January 2010 to January 2022. The primary outcomes evaluated were 1-year LVEF variation and all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: A total of 148 patients underwent evaluation, with a median LVEF of 40% [IQR: 35%-45%]. Prior to TAVI, 10.8% exhibited pre-existing left bundle branch block (LBBB), 10.8% demonstrated right bundle branch block (RBBB), and 13.5% had undergone PM implantation. At 1-month post-TAVI follow-up, 22.3% exhibited LBBB, 8.1% RBBB, and 31.7% PM presence, encompassing both prior and new-onset rhythm disturbances. At 1-year follow-up, patients with rhythm disturbances (RBBB, LBBB, or PM) at the 1-month evaluation showed a 5.4% lower LVEF variation compared to those without rhythm disturbances (95% CI: -8.1%, -2.7%; p<0.001). Excluding pre-existing rhythm disturbances, this difference increased to 6.7% (95% CI: -10.1%, -3.9%; p<0.001). LVEF recovery rates differed significantly, with 53.5% of patients without rhythm disturbances achieving an LVEF >50% 1 year after TAVI, contrasting with 15% in the rhythm disturbance group (p<0.001). For new-onset rhythm disturbances patients, median survival was 48 months (95% CI: 24.1, 72.0) compared to 82 months (95% CI: 52.5, 111.5), in those without previous or new rhythm disturbance (p=0.007).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Most of the population was male (62%) with a median age of 80. Patients with rhythm disturbances at 1-month had higher rates of arterial hypertension (p=0.037) and Atrial Fibrillation/Flutter (p=0.035). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Rhythm disturbances in TAVI patients extend beyond the consideration of PM implantation, impacting LVEF recovery and overall survival. Our findings underscore the significant influence of rhythm disturbances on TAVI benefits, highlighting the need to explore strategies for post-TAVI disturbance mitigation. Close monitoring of this population is essential to evaluate the potential advantages of resynchronization therapy.</span></span></p>
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