Prophylactic permanent pacemaker strategy in patients with right bundle branch block undergoing transcatheter aortic valve replacement
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Prophylactic permanent pacemaker strategy in patients with right bundle branch block undergoing transcatheter aortic valve replacement. / Fukutomi, Motoki; Hokken, Thijmen; Wong, Ivan; Bieliauskas, Gintautas; Daemen, Joost; de Jaegere, Peter; Van Mieghem, Nicolas; Søndergaard, Lars; De Backer, Ole.
I: Catheterization and Cardiovascular Interventions, Bind 98, Nr. 7, 2021, s. E1017-E1025.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Prophylactic permanent pacemaker strategy in patients with right bundle branch block undergoing transcatheter aortic valve replacement
AU - Fukutomi, Motoki
AU - Hokken, Thijmen
AU - Wong, Ivan
AU - Bieliauskas, Gintautas
AU - Daemen, Joost
AU - de Jaegere, Peter
AU - Van Mieghem, Nicolas
AU - Søndergaard, Lars
AU - De Backer, Ole
N1 - Publisher Copyright: © 2021 Wiley Periodicals LLC.
PY - 2021
Y1 - 2021
N2 - Objectives: To report on the experience with a selective prophylactic permanent pacemaker (PPx-PPM) implantation strategy in patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). Background: Pre-existing RBBB is an independent predictor for PPM after TAVR and has been linked to increased mortality. Methods: Hospital patient flow and longer-term clinical endpoints were compared for TAVR patients with pre-existing RBBB treated in a period with and without selective PPx-PPM strategy (2013–2020). Results: A total of 260 patients were included: 170 in the early period without PPx-PPM strategy and 90 patients in the late period with selective PPx-PPM strategy. A PPx-PPM was implanted in 44% of patients in the late period. Overall, 69% versus 80% of all patients in the early versus late period ended up with a PPM (p =.06). Streamlined transfemoral TAVR was routinely used from 2017—in this series of patients, both TAVR procedural time and hospital length of stay (LoS) were significantly shorter in the late versus early period (mean procedural time: 70 vs. 83 min and LoS ≥5 days: 15% vs. 40%; p <.05). No difference in all-cause/cardiovascular mortality was observed between both strategies, whereas cardiac rehospitalization was significantly higher for patients treated in the early versus late period (hazard ratio 2.33 [1.04–5.26]; p =.042)—this mainly due to (sub)acute PPM-implantation early after discharge. Conclusions: Selective prophylactic PPM implantation in TAVR candidates with pre-existing RBBB results in shorter TAVR procedural time and hospital LoS and prevents early cardiac rehospitalization related to complete heart block.
AB - Objectives: To report on the experience with a selective prophylactic permanent pacemaker (PPx-PPM) implantation strategy in patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). Background: Pre-existing RBBB is an independent predictor for PPM after TAVR and has been linked to increased mortality. Methods: Hospital patient flow and longer-term clinical endpoints were compared for TAVR patients with pre-existing RBBB treated in a period with and without selective PPx-PPM strategy (2013–2020). Results: A total of 260 patients were included: 170 in the early period without PPx-PPM strategy and 90 patients in the late period with selective PPx-PPM strategy. A PPx-PPM was implanted in 44% of patients in the late period. Overall, 69% versus 80% of all patients in the early versus late period ended up with a PPM (p =.06). Streamlined transfemoral TAVR was routinely used from 2017—in this series of patients, both TAVR procedural time and hospital length of stay (LoS) were significantly shorter in the late versus early period (mean procedural time: 70 vs. 83 min and LoS ≥5 days: 15% vs. 40%; p <.05). No difference in all-cause/cardiovascular mortality was observed between both strategies, whereas cardiac rehospitalization was significantly higher for patients treated in the early versus late period (hazard ratio 2.33 [1.04–5.26]; p =.042)—this mainly due to (sub)acute PPM-implantation early after discharge. Conclusions: Selective prophylactic PPM implantation in TAVR candidates with pre-existing RBBB results in shorter TAVR procedural time and hospital LoS and prevents early cardiac rehospitalization related to complete heart block.
KW - conduction disorder
KW - pacemaker
KW - right bundle branch block
KW - transcatheter aortic valve replacement
U2 - 10.1002/ccd.29914
DO - 10.1002/ccd.29914
M3 - Journal article
C2 - 34390167
AN - SCOPUS:85112385876
VL - 98
SP - E1017-E1025
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 7
ER -
ID: 303673693