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Exploring Atrioventricular Conduction Disturbances and Ventricular Pacing Rate in Patients with Pacemaker Implantation after Transcatheter Aortic Valve Implantation
Session:
Sessão de Posters 53 - Complicações de TAVI
Speaker:
Marta Catarina Almeida
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Almeida; Rafael Teixeira; André Lobo; Fábio Nunes; Inês Neves; Marta Leite; Mariana Brandão; Diogo Santos-Ferreira; Elisabeth Santos; Francisco Sampaio; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Atrioventricular (AV) conduction disturbances leading to in-hospital post-procedure pacemaker (PPM) implantation are a common complication after transcatheter aortic valve implantation (TAVI). Literature reporting ventricular pacing rate (VPR) during follow-up is scarce. The aim of this study was to explore AV conduction disturbances and VPR in patients with in-hospital PPM implantation after TAVI.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods:</span></strong><span style="font-family:"Arial",sans-serif"> Patients who underwent TAVI and needed in-hospital PPM implantation between 2019 and 2021 were included in a retrospective analysis. Patients with prior pacemakers and valve-in-valve procedures were excluded. Patients with VPR < 1% in one year follow-up were compared to patients with VPR ≥ 1%. A sub-analysis in patients with pacemakers capable of minimized ventricular pacing algorithms or active hysteresis</span><span style="font-family:"Arial",sans-serif"> was also conducted</span><span style="font-family:"Arial",sans-serif">. Mann-Whitney and Chi-square tests were used as appropriate. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results:</span></strong><span style="font-family:"Arial",sans-serif"> In-hospital PPM implantation was performed in 76 of 446 patients (17%). In these patients, median age was 81 years, 59% were male and 30% had history of atrial fibrillation/flutter (AF). Upon admission, 75% of the patients were in sinus rhythm and 50% had no intraventricular conduction disturbances. TAVI was an elective procedure in 72% of the cases and 67% received a balloon-expandable valve. Advanced AV block was the indication for PPM implantation in 68% of the patients (dual chamber in 60% of these cases). At discharge, 49% of the patients were in ventricular paced rhythm. During the initial year post-TAVI, 70% of the patients displayed a VPR ≥ 1%. Patients with history of AF had significantly higher odds of having a VPR ≥ 1% (OR 0.94, p = 0.02). There were no other factors related to VPR, including PR and QRS intervals or valve type. Among patients with pacemakers capable of minimized ventricular pacing algorithms or active hysteresis</span> <span style="font-family:"Arial",sans-serif">(n = 44), 40% of patients had a VPR < 1%.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> In-hospital post-TAVI pacemaker implantation was performed in 17% of patients, 68% due to advanced AV block. However, less than half of these patients were in ventricular paced rhythm at discharge. History of AF was associated with higher odds of having VPR ≥ 1% at follow-up. Notably, 40% of the patients with pacemakers capable of minimized ventricular pacing algorithms or active hysteresis had a VPR < 1%. This study emphasizes the need for identification of patients who may only require rhythm support due to transitory advanced AV conduction disturbances.</span></span></span></p>
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