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Mid-Term Ventricular Pacing Percentage in Patients Requiring Pacemaker Implantation Following TAVR: Insights from a Large Single-Center Experience
Session:
Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker:
Joana Guimarães
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:
Joana Guimarães; Diogo Fernandes; Eric Monteiro; Gonçalo Costa; João Ferreira; Vera Marinho; Elisabete Jorge; Marco Costa; Lino Gonçalves
Abstract
<p>BACKGROUND: Recent research indicates the potential recovery of atrioventricular (AV) conduction after pacemaker (PM) implantation subsequent to transcatheter aortic valve replacement (TAVR). However, there is limited knowledge regarding the long-term follow-up of these patients in such cases. Our objective is to assess the percentage of pacing in patients who underwent a TAVR procedure and experienced a conduction disturbance necessitating the implantation of a transvenous pacemaker.</p> <p> </p> <p>METHODS: We included all patients who underwent a TAVR procedure at our center from March 2020 to December 2022. Those who received a PM or an implantable cardioverter-defibrillator (ICD) before the TAVR procedure or within 30 days after were excluded from our analysis, as these cases were likely unrelated to TAVR. Patients meeting the eligibility criteria were categorized into two groups: one with complete atrioventricular block (AVB) after TAVR (with complete AVB group) and another without complete AVB (non-complete AVB group). The evaluation of effective right ventricular pacing percentage was conducted during a one-year follow-up period.</p> <p> </p> <p>RESULTS: 443 patients underwent TAVR in the study period (52.4% males, 81.4 ± 6.2 years). 60 patients already had a PM and were excluded. Out of the remaining 383 patients, 97 (25,3%) received a PM following TAVR, with 88 of them undergoing implantation within 30 days (mean time from TAVR to PM implantation: 3.3 ± 3.2 days). The main reason for PM implantation was complete atrioventricular block in 68 (77,3%) patients followed by alternating bundle branch block in 8 (9,1%) patients, LBBB plus 1st degree AVB in 5 (5,7%) patients and atrial fibrillation with slow A-V conduction in 3 (3,4%) patients. The initial follow-up, usually performed between 1-2 days after PM implantation, was conducted for 85 (96,6%) patients, while the follow-up at 1 year after PM implantation was available for 69 (78,4%) patients. At the first follow-up the percentage of pacing was significantly higher in the group with complete AVB vs. the group without complete AVB group (93.4% vs 55.4%, p=0.007). This difference was even more significant at 1-year follow-up (88.3% vs 14%; P =0.004)</p> <p> </p> <p>CONCLUSION: Patients who needed a PM due to persistent complete AVB after TAVR were less likely to exhibit recovery in AV conduction, whereas patients receiving PMs for other indications demonstrated a low pacing percentage during follow-up. The outcomes of our study might influence the decision regarding the optimal timing for PM implantation post-TAVR and the potential consideration for using a leadless PM.</p>
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