Author + information
- Brett Oestreich1,
- Selcuk Adabag2,
- Rosemary Kelly3,
- Gregory Helmer4,
- Ganesh Raveendran5,
- Demetris Yannopoulos1,
- Timinder Biring6 and
- Santiago Garcia1
A significant proportion of patients that receive a permanent pacemaker (PPM) after TAVR is not pacemaker-dependent during follow-up. Tissue edema and inflammation, which occur at the device landing zone during valve deployment, may contribute to the pathophysiology of conduction block. As such, glucocorticoids may have therapeutic effects due to their anti-edema and anti-inflammatory properties.
We hypothesized that exposure to glucocorticoids prior to TAVR will reduce the incidence of conduction abnormalities requiring PPM implantation after TAVR. We included 167 consecutive patients treated with TAVR at the Minneapolis VA Medical Center and University of Minnesota. Exposure to glucocorticoids was assessed by linking electronic medical and pharmacy records. The primary outcome was a new PPM within 30-days of the index TAVR procedure. Patients with pre-existing left bundle branch block or PPM were excluded.
Of the 167patients included, 16 (9.5%) were exposed to glucocorticoids prior to TAVR.No differences in age, STS score, pre-existing right bundle branch block or valve type were seen among patients exposed to glucocorticoids versus those who were unexposed (table). Patients exposed to glucocorticoids were more likely to have moderate/severe COPD (43% versus 18%, p<0.01). The cumulative incidence of PPM implantation at 30-days after TAVR was 18%. None of the patients exposed to glucocorticoids required a PPM while 30 (19%) of the unexposed patients did (p=0.04).
|Steroids (n=16)||No Steroids (n=151)||P value|
|Age||76 (10)||80 (9)||0.07|
|STS median (IQR)||5.8 (3.9-7.9)||5.6 (3.1-8.8)||0.80|
|COPD (mod/severe)||(7) 43%||(28) 18%||<0.01|
|Right bundle brunch block||(1) 7%||21 (13%)||0.49|
|Implantation Depth (mm, IQR)||4 (3.1-4.5)||4.4 (3.5-5.8)||0.28|
|Sapien XT||7 (43%)||54 (36%)||0.58|
|Sapien 3||8 (50%)||79 (52%)||0.87|
|Corevalve/Evolut||1 (7%)||17 (12%)||0.55|
|New Pacemaker||0 (0%)||30 (19%)||0.04|
Exposure to glucocorticoids prior to TAVR is associated with reduced incidence of PPM requirement. Tissue edema and inflammation may be significant contributors to the pathophysiology of conduction abnormalities after TAVR and could represent a therapeutic target.
STRUCTURAL: Valvular Disease: Aortic