Prospective Validation of a Pre-Specified Algorithm for the Management of Conduction Disturbances Following Transcatheter Aortic Valve Replacement. The PROMOTE Study.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2024-12-16 DOI:10.1016/j.hrthm.2024.12.019

Josep Rodés-Cabau, Luis Nombela-Franco, Guillem Muntané-Carol, Gabriela Veiga, Ander Regueiro, Tamim Nazif, Vicenç Serra, Lluis Asmarats, Henrique B Ribeiro, Azeem Latib, Anthony Poulin, Asim N Cheema, Pilar Jiménez-Quevedo, Joan Antoni Gomez-Hospital, Aritz Gil Ongay, Rami Gabani, Dabit Arzamendi, Michael Brener, Alvaro Calabuig, Andrea Scotti, Marco Antonio S Gelain, Marino Labinaz, Pedro Cepas, Jorge Nuche, Melanie Côté, Juan H Del Portillo, François Philippon

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引用次数: 0

Abstract

Background: There is a large variability regarding the management of conduction disturbances (CDs) after TAVR.

Objectives: To validate a pre-specified algorithm for managing CDs in patients undergoing TAVR.

Methods: Prospective multicenter study including consecutive patients without prior pacemaker undergoing TAVR. Patients were stratified in different groups according to the presence of prior right bundle branch block (RBBB) and the occurrence of CDs during the procedure: no prior RBBB and no CDs (group NCD), prior RBBB and no CDs (group RBBB-NCD), and occurrence of CDs (group CD). A management algorithm was pre-specified for each group. Permanent pacemaker (PPM) and mortality (overall, sudden cardiac death) at 30 days were the primary endpoints.

Results: A total of 2110 TAVR recipients were included. Patients were distributed in NCD (32.0%), RBBB-NCD (5.1%), and CD (62.9%) groups. . A total of 329 patients (15.6%) received a PPM at 30 days , with a PPM rate of 5.5%, 15.9%, 20.7%, in NCD, RBBB-NCD, and CD groups, respectively (p<0.001). The PPM rate was 17.4% and 57.2% in patients with procedural new-onset LBBB and HAVB/CHB, respectively. There were no differences in 30-day all-cause mortality and sudden cardiac death between groups (NCD: 1.2/0.2%, RBBB-NCD: 0/0%, CDs 0.7/0.1%; p=0.45/0.99 for all-cause mortality and sudden cardiac death, respectively).

Conclusions: A pre-specified strategy for the management of CDs in contemporary TAVR recipients was feasible and safe, with no increased mortality and an extremely low rate of sudden cardiac death among patients with CDs. However, PPM rates remained high, and continued efforts for preventing the occurrence of CDs are warranted.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.