Author + information
- Ijeoma Ananaba Ekeruo,
- Michael Firstenberg,
- Roxana Mehran,
- David Fullerton,
- Vinod Thourani,
- Kyle Mitchell,
- Gina De La Guardia,
- Prakash Balan,
- Alistair Philips,
- Jodie Hurwitz and
- Tom Nguyen
Background: Although the potential for pacemaker implantation (PPM) following transcatheter aortic valve replacement (TAVR) has been well documented, there has been significant variance in the timing of post-TAVR PPM implantation. To obtain a better understanding of current real-world algorithms, we distributed a questionnaire among U.S. TAVR centers.
Methods: As part of an American College of Cardiology (ACC) multidisciplinary collaborative councils (Surgeon's, Interventional Cardiology, and Electrophysiology), a survey was constructed with different PPM scenarios encountered after TAVR implantation. The surveys were designed to explore decision making processes and timing of PPM implantation after TAVR. A confidential survey was electronically distributed to U.S. TAVR centers.
Results: A total of 48 surveys were completed (response rate of 27%) with equal representation by surgeons (42%) and interventional cardiologists (56%). Centers performed on average 4-6 TAVRs per week. Primary decision makers regarding timing of PPM implantation included the following: joint decision by heart team (44%), electrophysiology (33%), interventional cardiology (21%), and cardiothoracic surgery (2%). The majority (59%) of PPMs were placed within 48 hours of the procedure. Most centers were in agreement that PPM implantation was warranted for new complete AV block (42%). However, all other conduction abnormalities (including new high grade AV block, sinus node dysfunction, LBBB, bifascicular block, and significant first degree AV block) required only monitoring and no new PPM. Monitoring using the temporary pacemaker utilized during the procedure was preferred over placing a new temporary permanent pacing device. In addition, it was widely agreed that while pre-existing conduction abnormalities warranted increased monitoring, they did not reach the threshold of pacemaker placement, temporary or otherwise.
Conclusions: Though there is a paucity of literature guiding the decision making process of PPM implantation after TAVR, this study provides a framework regarding the timing and algorithm from leading TAVR centers. Further studies are warranted to establish guidelines in this area.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: PCI and TAVR in Complex Patients
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1239-129
- 2017 American College of Cardiology Foundation