Author + information
- Ron Waksman,
- Toby Rogers,
- Mithun Devraj,
- Arie Steinvil,
- Edward Koifman,
- Michael Lipinski,
- Jiaxiang Gai,
- Rebecca Torguson,
- Petros Okubagzi,
- Lowell Satler and
- Augusto Pichard
Background: Permanent pacemaker (PPM) implantation following TAVR is associated with increased morbidity and healthcare costs. However, device interrogation reveals that up to 50% of patients who receive a PPM post-TAVR do not use it.
Methods: In 2013, we implemented a clinical strategy of invasive electrophysiology study (EPS) in all TAVR patients with new conduction abnormalities but no absolute indication for PPM. Baseline demographic, TAVR and EPS procedural, and follow-up data were collected.
Results: 614 consecutive TAVR patients between 2013-15 were included. PPM implantation rate was higher for self- vs. balloon-expandable valves (34.8% vs. 20.0%, p<0.001). Overall, 19.1% of patients underwent PPM implantation without EPS. Hospital length of stay was longer for those who required PPM (9.01±8.4 vs. 6.5±5.6 days, p=0.001). 15.5% of patients underwent EPS, most commonly for new bundle branch block and prolonged PR interval. Among patients who underwent EPS, 70.1% did not receive a PPM, and although 1-year mortality was numerically higher, the difference was not statistically significant (13.4% vs. 7.1%, p=0.50). Among patients with no PPM, there was no difference in 1-year mortality between patients with or without EPS (13.4% vs. 21.1%, p=0.19).
Conclusions: A strategy of EPS prior to PPM implantation in patients without absolute indication for PPM appears safe and enables over 70% of patients to avoid PPM implantation. This strategy could reduce patient morbidity and healthcare costs.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Miscellaneous and Surgical Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1236-087
- 2017 American College of Cardiology Foundation