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 -