Same-Day Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-07-28 DOI:10.1016/j.jcin.2025.05.041

Quentin Fischer MD , Marina Urena MD, PhD , Guillem Muntané-Carol MD, PhD , Alberto Alperi MD, PhD , Luis Nombela-Franco MD, PhD , Gabriela Veiga MD, PhD , Ander Regueiro MD, PhD , Gaspard Suc MD , Rafael Romaguera MD , Pablo Avanzas MD, PhD , Gabriela Tirado-Conte MD , Jose M. de la Torre Hernandez MD, PhD , Pedro Cepas-Guillén MD, PhD , Mélanie Côté MSc , François Philippon MD , Josep Rodés-Cabau MD, PhD

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Abstract

Background

The development of conduction disturbances leading to permanent pacemaker implantation (PPI) remains the main complication of transcatheter aortic valve replacement (TAVR).

Objectives

The aim of this study was to determine the impact of same-day PPI in patients developing persistent complete or high-degree atrio-ventricular block (CHB/HAVB) during TAVR.

Methods

This was a multicenter study including consecutive patients without prior pacemaker and developing procedural persistent CHB/HAVB. Baseline, procedural, and follow-up clinical and pacing interrogation data were prospectively collected in a dedicated database.

Results

A total of 584 consecutive patients (mean age: 81 ± 8 years, 50% of women) were included; 157 (26.9%) had same-day PPI (SDP), and 427 (73.1%) were observed to assess for potential conduction recovery (n-SDP). In the n-SDP group, 376 patients (88%) finally received a PPI at a median of 3 [1-4] days following TAVR. There were no differences in periprocedural complications between groups, including pacemaker pocket hematomas, and the hospitalization length was shorter in the SDP group (5 [2-7] days vs 8[4-9] days; P < 0.001). At 1-month follow-up, the median percentage of ventricular pacing (SDP: 96% (22%-99%), n-SDP: 90% (10%-99%); P = 0.203) and pacemaker dependency rate (SDP: 56%, n-SDP: 50%; P = 0.277) were similar in both groups.

Conclusions

In patients developing procedural persistent CHB/HAVB during TAVR, SDP was safe and associated with a shorter hospitalization length and a very high pacing burden at 30 days. These results, along with the very low rate of conduction recovery in the n-SDP group, would support SDP as a reasonable strategy in these patients.

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经导管主动脉瓣置换术后同日永久起搏器植入

背景：传导障碍导致永久性起搏器植入（PPI）仍然是经导管主动脉瓣置换术（TAVR）的主要并发症。目的本研究的目的是确定当天PPI对TAVR期间发生持续性完全或高程度房室传导阻滞（CHB/HAVB）的患者的影响。方法本研究是一项多中心研究，包括连续无起搏器且发生程序性持续性CHB/HAVB的患者。基线、程序和随访的临床和起搏询问数据前瞻性地收集在专用数据库中。结果共纳入584例患者，平均年龄81±8岁，女性占50%；157例（26.9%）有当日PPI (SDP)， 427例（73.1%）观察到潜在传导恢复（n-SDP）。在n-SDP组中，376名患者（88%）最终在TAVR后中位3[1-4]天接受了PPI治疗。两组患者术中并发症无差异，包括起搏器袋血肿，且SDP组住院时间较短（5 [2-7]d vs 8[4-9] d）；P & lt;0.001)。在1个月的随访中，心室起搏(SDP: 96% (22%-99%), n-SDP: 90% (10%-99%)；P = 0.203)和起搏器依赖率(SDP: 56%, n-SDP: 50%；P = 0.277)。结论在TAVR期间发生程序性持续性CHB/HAVB的患者中，SDP是安全的，且住院时间较短，30天起搏负担非常高。这些结果，以及n-SDP组极低的传导恢复率，将支持SDP作为这些患者的合理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.