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The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation.
Krishnaswamy, Amar; Sammour, Yasser; Mangieri, Antonio; Kadri, Amer; Karrthik, Antonette; Banerjee, Kinjal; Kaur, Manpreet; Giannini, Francesco; Pagliaro, Beniamino; Ancona, Marco; Pagnesi, Matteo; Laricchia, Alessandra; Weisz, Giora; Lyden, Megan; Bazarbashi, Najdat; Gad, Mohamed; Ahuja, Keerat; Mick, Stephanie; Svensson, Lars; Puri, Rishi; Reed, Grant; Rickard, John; Colombo, Antonio; Kapadia, Samir; Latib, Azeem.
Affiliation
  • Krishnaswamy A; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: krishna2@ccf.org.
  • Sammour Y; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Mangieri A; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
  • Kadri A; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Karrthik A; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Banerjee K; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Kaur M; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Giannini F; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
  • Pagliaro B; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ancona M; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Pagnesi M; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Laricchia A; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
  • Weisz G; Department of Cardiology, Montefiore Medical Center, New York, New York.
  • Lyden M; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Bazarbashi N; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Gad M; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Ahuja K; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Mick S; Department of Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Svensson L; Department of Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Puri R; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Reed G; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Rickard J; Section of Cardiac Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Colombo A; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
  • Kapadia S; Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Latib A; Department of Cardiology, Montefiore Medical Center, New York, New York.
JACC Cardiovasc Interv ; 13(9): 1046-1054, 2020 05 11.
Article in En | MEDLINE | ID: mdl-32305392
ABSTRACT

OBJECTIVES:

The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI).

BACKGROUND:

Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI.

METHODS:

Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI.

RESULTS:

A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%).

CONCLUSIONS:

Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.
Subject(s)
Key words

Full text: 1 Database: MEDLINE Main subject: Aortic Valve Stenosis / Electrophysiologic Techniques, Cardiac / Atrioventricular Block / Transcatheter Aortic Valve Replacement Type of study: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Aged80 / Female / Humans / Male Country/Region as subject: America do norte / Europa Language: En Journal: JACC Cardiovasc Interv Journal subject: ANGIOLOGIA / CARDIOLOGIA Year: 2020 Type: Article

Full text: 1 Database: MEDLINE Main subject: Aortic Valve Stenosis / Electrophysiologic Techniques, Cardiac / Atrioventricular Block / Transcatheter Aortic Valve Replacement Type of study: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Aged80 / Female / Humans / Male Country/Region as subject: America do norte / Europa Language: En Journal: JACC Cardiovasc Interv Journal subject: ANGIOLOGIA / CARDIOLOGIA Year: 2020 Type: Article