Author + information
- Antonio Mangieri1,
- Giuseppe Lanzillo2,
- Letizia Bertoldi3,
- Richard Jabbour4,
- Damiano Regazzoli1,
- Marco Ancona1,
- Akihito Tanaka1,
- Satoru Mitomo5,
- Claudio Montalto6,
- Matteo Pagnesi6,
- Francesco Giannini1,
- Matteo Montorfano6,
- Alaide Chieffo1,
- Josep Rodés-Cabau7,
- Ottavio Alfieri8,
- Antonio Colombo9 and
- Azeem Latib1
- 1Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 2San Raffaele Scientific Institute, Milan, Italy., Milano, Milan, Italy
- 3San Raffaele Scientific Institute, Milano, Milan, Italy
- 4Imperial College London, London, United Kingdom
- 5IRCCS San Raffaele Scientific Institute, Milan, Milan, Italy
- 6San Raffaele Scientific Institute, Milan, Milan, Italy
- 7Quebec Heart and Lung Institute/Laval University, Quebec, Quebec, Canada
- 8San Raffaele Hospital, Milan, Milan, Italy
- 9Interventional Cardiology Institute San Raffaele Hospital - Stamford Hospital - Columbia University - Centro Cuore Columbus, Milan, Milan, Italy
To analyse and determine the predictors of advanced conduction disturbances requiring late (> 48 hours) permanent pacemaker implantation (PPM) after transcatheter aortic valve implantation (TAVI).
Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume centre in Milan, Italy between October 2007 and July 2015. Clinical and procedural data were collected to determine predictors of conduction disturbances requiring a PPM at least 48 hours following TAVI.
The overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 hours after TAVI. The final analysis included 611 patients. Of these, 54 patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 hours following TAVI. PPM implantation was performed after a mean time of 6.1±3.9 days after TAVI. Reasons for PPM implantation included: 1) complete atrio-ventricular block (n= 42, 77%); 2) Mobitz type II block (n=4; 7%); 3) pathological pauses and asystole (n=7, 6.6%), and 4) symptomatic junctional rhythm (n=1; 1.8%). Patients who developed an advanced conduction delay and received a late PPM implantation had a wider QRS width at baseline (113±25 msec vs. 105±23 msec; p=0.009). Baseline right bundle branch block was more frequently present in the group of patients who received a late PPM (12.9%±5.3%; p=0.026). Patients that required a late PPM were more likely to have a self-expandable valve implanted (51.8%vs. 31.9%, p=0.003). Multivariable analysis revealed that PR length after TAVI was an independent predictor of the need for a PPM (OR 1.02; CI 95%: 1.01-1.03; p=0.0001), with a post procedural PR length of 179 msec measured 48 hours after TAVI identified as the optimal cutoff point (sensitivity 82%; specificity 44%) for predicting late PPM implantation, with corresponding area under the receiver operating characteristic curve of 0.738 (95% CI: 0.64-0.82; p=0.001).
This preliminary analysis indicates that post-procedural PR length is the only independent predictor of late (≥48 hours) advanced conduction disturbances requiring PPM implantation after TAVI. Our study suggests that a simple ECG analysis could help in preventing potential lethal advanced conduction disturbances after TAVI.
STRUCTURAL: Valvular Disease: Aortic