Atrioventricular conduction in patients undergoing pacemaker implant following self-expandable transcatheter aortic valve replacement.
Pacing Clin Electrophysiol
; 42(7): 980-988, 2019 07.
Article
in En
| MEDLINE
| ID: mdl-30969440
ABSTRACT
BACKGROUND:
Heart block requiring a pacemaker is common after self-expandable transcatheter aortic valve replacement (SE-TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown.OBJECTIVE:
To evaluate the long-term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR.METHODS:
All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE-TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow-up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery.RESULTS:
Following SE-TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow-up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long-term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio 0.53 [0.28-0.86]/mm, P = 0.02) predicted lack of conduction recovery.CONCLUSIONS:
Half of the patients undergoing CIED placement for heart block following SE-TAVR recovered AV conduction within several months and maintained this over an extended follow-up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Pacemaker, Artificial
/
Atrioventricular Block
/
Transcatheter Aortic Valve Replacement
/
Heart Conduction System
Type of study:
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
Pacing Clin Electrophysiol
Year:
2019
Type:
Article