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Long-term impact of pacemaker implantation after TAVI: a subgroup analysis according to previous intraventricular conduction disturbances
Session:
Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker:
Julien Lopes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Julien Lopes; Bárbara Lacerda Teixeira; Tiago Mendonça; Inês Rodrigues; Ruben Ramos; António Fiarresga; Guilherme Portugal; Pedro Cunha; Ana Lousinha; Rui Cruz Ferreira; Duarte Cacela; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Introduction:</span></span></span></strong> <span style="font-family:"Calibri",sans-serif">C</span><span style="font-family:"Calibri",sans-serif">onduction </span><span style="font-family:"Calibri",sans-serif">system </span><span style="font-family:"Calibri",sans-serif">disturbances</span><span style="font-family:"Calibri",sans-serif">,</span> <span style="font-family:"Calibri",sans-serif">f<span style="background-color:white"><span style="color:black">requently requiring permanent pacemaker (PM) implantation, </span></span></span><span style="font-family:"Calibri",sans-serif">remain one of the most common </span><span style="font-family:"Calibri",sans-serif">procedural </span><span style="font-family:"Calibri",sans-serif">complication after </span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">transcatheter aortic valve implantation (TAVI)</span></span></span><span style="font-family:"Calibri",sans-serif">. </span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Whether the permanent ventricular pacing has a deleterious impact on the prognosis of this population remains unclear. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Objectives:</span></strong><span style="font-family:"Calibri",sans-serif"> To assess the long-term impact of permanent PM implantation in clinical outcomes after TAVI. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods: </span></strong><span style="font-family:"Calibri",sans-serif">Retrospective analysis of consecutive patients (P) who underwent TAVI between 2009 and 2021 <span style="background-color:white"><span style="color:black">in a single tertiary center.</span></span> <span style="background-color:white"><span style="color:black">P with a PM implanted before TAVI or with in-hospital mortality were excluded. </span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">PM implantation post-TAV</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">I</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> was defined as an implant during hospital stay </span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">after</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> TAV</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">I</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> or in one month after discharge</span></span></span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">. Kaplan Meier survival curves were used to estimate the impact of permanent PM after TAVI, regarding the composite endpoint of all-cause mortality and heart failure (HF) hospitalization during a 4 years follow-up period, followed by </span></span></span><span style="font-family:"Calibri",sans-serif">subgroup analysis according to intraventricular conduction disturbances at baseline<span style="background-color:white"><span style="color:black">.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> 549P (82±6.6 years, 56.8% female, left ventricular ejection fraction 53±10%, aortic valve area 0.7±0.2 cm2) were included. At baseline, 108P (20%) had intraventricular conduction disturbances (50P with right bundle branch block [RBBB] and 58P with left bundle branch block [LBBB]). 127P(23%) required PM implantation after TAVI. Baseline characteristics were similar between groups, except for age, gender, previous valvular surgery and RBBB. At 48 months follow-up, 35% (n=193) met the composite endpoint, that was similar between both groups (35.8% vs. 34.1%, p=0.731). Kaplan-Meier survival curves revealed no difference in the composite endpoint between the two groups (log-rank p=0.170). Further analysis of subgroups, according to the presence or absence of baseline intraventricular conduction disturbances, revealed a significant difference among the subgroup of P without previous intraventricular conduction disturbances that underwent PM implantation after TAVI (log rank p=0.02). This difference in the composite endpoint was not found in the subgroups of P with RBBB (log rank p=0.656) or LBBB (log rank p=0.975) at baseline.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Conclusions:</span></span></span></strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Permanent PM implant after TAVI does not have an impact on long-term HF hospitalization and mortality. However, in the specific subgroup of P without previous intraventricular conduction disturbances, PM implantation seems to be associated with worse prognosis.</span></span></span></span></span></p>
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