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- Title
Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement.
- Authors
Leong, Derek; Sovari, Ali A.; Ehdaie, Ashkan; Chakravarty, Tarun; Liu, Qiang; Jilaihawi, Hasan; Makkar, Rajendra; Wang, Xunzhang; Cingolani, Eugenio; Shehata, Michael
- Abstract
<bold>Background: </bold>Damage to the cardiac conduction system requiring permanent pacemaker (PPM) implantation is a known adverse outcome of transcatheter aortic valve replacement (TAVR). A permanent-temporary pacemaker (PTPM) is a device that involves an active-fixation lead attached to an external pulse generator taped to the skin. We reviewed the utility of PTPMs as a temporary bridge measure after TAVR in patients with conduction abnormalities that do not meet conventional criteria for PPM placement.<bold>Methods: </bold>Between January 01, 2013 and December 31, 2015, we analyzed 67 patients who received PTPM after TAVR. Baseline demographics, comorbidities, type and size of the valve, pre-TAVR electrocardiograms (ECGs), post-TAVR ECGs at 1 day, 1 month, and 6 months, and pacemaker interrogation results were reviewed for each patient if available.<bold>Results: </bold>The mean age of patients was 80.5 ± 9.1 years. PTPM were placed for 2.3 ± 2.4 days. Among these patients, 44.8% (n = 30) received a PPM prior to discharge. Male gender (OR 2.84, 95% CI 1.05-7.69, p = 0.05) and an increase in QRS duration post-TAVR (p = 0.01) were associated with PPM placement. Pacemaker interrogation data of 11 patients with PPM revealed that 27% (n = 3) had < 1% V-pacing requirements and < 10% A-pacing requirements.<bold>Conclusions: </bold>In post-TAVR patients who develop conduction abnormalities that do not meet conventional PPM implantation indications, PTPM safely provides a time period for further assessment and may prevent unnecessary PPM implantation. Male gender and an increase in QRS duration post-TAVR are associated with PPM implantation. Additionally, some patients may recover from their conduction disturbances and demonstrate low pacemaker utilization.
- Subjects
CARDIAC pacemakers; HEART conduction system; AORTIC valve surgery; COMORBIDITY; ELECTROCARDIOGRAPHY; DISEASES
- Publication
Journal of Interventional Cardiac Electrophysiology, 2018, Vol 52, Issue 1, p111
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-018-0345-z