Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis.

Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.

Registro español de desfibrilador automático implantable. XIX informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2022) / Spanish implantable cardioverter-defibrillator registry. 19th official report of Heart Rhythm Association of the Spanish Society of Cardiology (2022)

Introducción y objetivos: Se presentan los datos de implantes de desfibrilador automático implantable en España en el año 2022.Métodos: Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos durante el implante, a mano o a través de una página web.Resultados: Durante 2022, han participado en el registro 170 hospitales. Se han recibido 7.693 formularios, frente a los 7.970 comunicados por la European Confederation of Medical Suppliers Associations (Eucomed), lo que representa un 96,5% de los dispositivos. La tasa total de implantes registrados fue 162/millón de habitantes (168 según Eucomed), un ligero incremento respecto a años anteriores. Las diferencias entre las comunidades autónomas persisten, así como nuestra última posición respecto a los países europeos que participan en la Eucomed.Conclusiones: Los datos del registro de 2022 reflejan la recuperación completa de la actividad tras el impacto de la pandemia de la COVID-19 en 2020. Pese a la leve mejora, se mantiene nuestra posición en Europa y también las grandes diferencias entre nuestras comunidades autónomas.(AU)

Introduction and objectives: This article presents data on implantable cardioverter-defibrillator implants in Spain in 2022.Methods: The data were collected from implantation centers, which voluntarily completed a data collection sheet during the implantation process, either manually or through a web page.Results: In 2022, 170 hospitals participated in the registry. A total of 7693 forms were received compared with the 7970 reported by Eucomed (European Confederation of Medical Suppliers Associations), representing 96.5% of the devices. The total rate of registered implants was 162/million inhabitants (168 according to Eucomed), showing a slight increase compared with previous years. Disparities persisted among autonomous communities and Spain continued to have the lowest implantation rate among countries participating in Eucomed.Conclusions: The data from the registry for 2022 reflect the complete recovery of activity after the impact of the COVID-19 pandemic in 2020. Despite a slight improvement, there was no significant change in our position in Europe or in the substantial differences among autonomous communities.(AU)

Spanish implantable cardioverter-defibrillator registry. 19th official report of Heart Rhythm Association of the Spanish Society of Cardiology (2022).

INTRODUCTION AND OBJECTIVES: This article presents data on implantable cardioverter-defibrillator implants in Spain in 2022. METHODS: The data were collected from implantation centers, which voluntarily completed a data collection sheet during the implantation process, either manually or through a web page. RESULTS: In 2022, 170 hospitals participated in the registry. A total of 7693 forms were received compared with the 7970 reported by Eucomed (European Confederation of Medical Suppliers Associations), representing 96.5% of the devices. The total rate of registered implants was 162/million inhabitants (168 according to Eucomed), showing a slight increase compared with previous years. Disparities persisted among autonomous communities and Spain continued to have the lowest implantation rate among countries participating in Eucomed. CONCLUSIONS: The data from the registry for 2022 reflect the complete recovery of activity after the impact of the COVID-19 pandemic in 2020. Despite a slight improvement, there was no significant change in our position in Europe or in the substantial differences among autonomous communities.

Reablation in Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection: Cryoballoon versus Radiofrequency as Index Ablation Procedures.

Pulmonary vein (PV) isolation is a well-established rhythm control therapy in atrial fibrillation (AF). Currently, there is no consensus on which ablation technique to use for the first procedure, cryoballoon (CB) or radiofrequency (RF). A retrospective cohort study was conducted on 1055 patients who underwent a first ablation, to assess both techniques based on the need for reablation. Patients with CB (n = 557) and RF (n = 498) ablations were clinically characterized and the need for reablation during a 30-month follow-up was used as the primary endpoint. Independent variables were analyzed to identify potential predictors. The need for reablation was significantly lower in the CB group than in the RF group (hazard ratio = 0.45 and 95% confident interval = 0.32−0.61; p < 0.001); in both paroxysmal and persistent AF, using a full-adjusted regression Cox model by age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, severe obstructive sleep apnea, dilated left atrium, persistent AF and early recurrence. RF ablation, dilated left atrium, persistent AF and early recurrence were identified as independent predictors of reablation. In addition, the CB-redo subgroup had a lower PV reconnection than the RF-redo subgroup. In conclusion, CB ablation suggests a reduction in the need for reablation and lower PV reconnection during the follow-up than RF ablation.

Spanish implantable cardioverter-defibrillator registry. 18th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021).

INTRODUCTION AND OBJECTIVES: This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021. METHODS: The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure. RESULTS: In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for "name of implanting hospital" to 8.9% for "implanting hospital". In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed. CONCLUSIONS: The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities.

Spanish Implantable Cardioverter-defibrillator Registry. 17th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2020).

INTRODUCTION AND OBJECTIVES: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2020. METHODS: The data in this registry were drawn from implantation centers, which voluntarily completed a data collection sheet. RESULTS: In 2020, 7056 implant sheets were received compared with 7106 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 99% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.8% for the field "name of the implanting hospital" to 2.6% for the variable "referral hospital". A total of 173 hospitals performed ICD implants and participated in the registry, which is a similar figure to that in 2019 (n=172). The total rate of registered implants was 149/million inhabitants (150 according to Eucomed), revealing a slight reduction in implants in Spain in 2020 as a result of the impact of the COVID-19 pandemic. This reduction was uneven among the autonomous communities. CONCLUSIONS: The Spanish Implantable Cardioverter Defibrillator Registry for 2020 shows an improvement in the rate of implants reported and a reduction in the number of ICD implants, which likely reflects the decrease in hospital activity not related to the treatment of COVID-19 infection. Similar to previous years, the total number of implants in Spain is still much lower than the average for the European Union, with an increase in the differences between Spanish autonomous communities.

Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients.

OBJECTIVES: The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients. BACKGROUND: Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited. METHODS: A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female subjects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defibrillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 ± 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia-treated incidence and death during the follow-up period, with a particular focus on primary prevention patients. RESULTS: Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p = 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular arrhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p = 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p = 0.25). CONCLUSIONS: Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.

Registro Español de Desfibrilador Automático Implantable. XVI Informe Oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2019) / Spanish Implantable Cardioverter-defibrillator Registry. 16th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019)

INTRODUCCIÓN Y OBJETIVOS: Se presentan los datos correspondientes a los implantes de desfibrilador automático implantable (DAI) en España en el año 2019. MÉTODOS: Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos. RESULTADOS: En 2019 se recibieron 7.003 hojas de implante, frente a las 7.389 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations), lo que implica que se han recogido datos del 94,8% de los dispositivos implantados en España. La cumplimentación de la hoja de implante osciló entre el 99,7% en el campo «nombre del hospital implantador» y el 17,8% en la variable «hospital de referencia». En 2019, los hospitales que realizaron implantes de DAI y participaron en el registro fueron 172, cifras similares a las de 2018 (173). La tasa total de implantes registrados fue 149/millón de habitantes; según los datos de Eucomed, 157. A pesar de que este valor supone el máximo de la serie histórica, sigue siendo muy inferior a la tasa media de implantes de DAI en Europa (303). CONCLUSIONES: El Registro Español de Desfibrilador Automático Implantable de 2019 recoge un crecimiento en el número de implantes de DAI y es el año en el que se han implantado más DAI en España. Sin embargo, y de modo similar que años previos, el número total de implantes en España sigue siendo muy inferior a la media de la Unión Europea, con importantes diferencias entre las comunidades autónomas españolas

INTRODUCTION AND OBJECTIVES: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2019. METHODS: The data were drawn from implant centers voluntarily completing a data collection sheet. RESULTS: In 2019, 7003 implant sheets were received compared with the 7389 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 94.8% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.7% in the field "name of the implanting hospital" to 17.8% in the variable "reference hospital". In 2019, 172 hospitals performed ICD implants and participated in the registry, a figure similar to that of 2018 (173). The total rate of registered implants was 149/million inhabitants; the rate reported by Eucomed was 157. Although this value represents the highest in the historical series, it is still much lower than the average rate of ICD implants in Europe (303). CONCLUSIONS: The Spanish Implantable Cardioverter-Defibrillator Registry for 2019 reflects a growth in the number of ICD implants and is the year with the highest number of ICD implants in Spain. However, similar to previous years, the total number of implants in Spain is still much lower than the European Union average, with substantial differences between Spanish autonomous communities

Spanish Implantable Cardioverter-defibrillator Registry. 16th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019).

INTRODUCTION AND OBJECTIVES: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2019. METHODS: The data were drawn from implant centers voluntarily completing a data collection sheet. RESULTS: In 2019, 7003 implant sheets were received compared with the 7389 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 94.8% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.7% in the field "name of the implanting hospital" to 17.8% in the variable "reference hospital". In 2019, 172 hospitals performed ICD implants and participated in the registry, a figure similar to that of 2018 (173). The total rate of registered implants was 149/million inhabitants; the rate reported by Eucomed was 157. Although this value represents the highest in the historical series, it is still much lower than the average rate of ICD implants in Europe (303). CONCLUSIONS: The Spanish Implantable Cardioverter-Defibrillator Registry for 2019 reflects a growth in the number of ICD implants and is the year with the highest number of ICD implants in Spain. However, similar to previous years, the total number of implants in Spain is still much lower than the European Union average, with substantial differences between Spanish autonomous communities.

Registro Español de Desfibrilador Automático Implantable. XV Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2018) / Spanish Implantable Cardioverter-defibrillator Registry. 15th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2018)

Introducción y objetivos: Se presentan los datos correspondientes a los implantes de desfibrilador automático implantable (DAI) en España comunicados al Registro Español de Desfibrilador Automático Implantable en el año 2018. Métodos: Los datos de este registro incluyen tanto los primoimplantes como los recambios de generador y se documentan a partir de una hoja de recogida de datos que voluntariamente cumplimentan los centros implantadores. Resultados: En el año 2018 se recibieron 6.421 hojas de implante, frente a las 7.077 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations). Esto representa datos del 90,7% de los dispositivos implantados en España. El grado de cumplimiento osciló entre el 99,6% en el campo «nombre del hospital implantador» y el 12,4% en «población de residencia». Comunicaron sus datos al registro 173 hospitales, lo que supone una ligera disminución con respecto a los que participaron en 2017 (181). Conclusiones: El Registro Español de Desfibrilador Automático Implantable del año 2018 recoge un crecimiento en el número de implantes de DAI después de la reducción observada en 2017 y es el año en que se ha implantado un mayor número de DAI en España. El número total de implantes en España sigue siendo muy inferior a la media de la Unión Europea, con importantes diferencias entre comunidades autónomas

Introduction and objectives: This article presents the data corresponding to automated implantable cardioverter-defibrillator (ICD) implants in Spain reported to the Spanish Registry in 2018. Methods: The data in this registry include both primary implants and generator replacements and were gathered from a data collection sheet voluntarily completed by implantation centers. Results: In 2018, 6421 implant sheets were received compared with 7077 reported by Eucomed (European Confederation of Medical Suppliers Associations). This represents data on 90.7% of the devices implanted in Spain. Compliance ranged between 99.6% for the field "name of the implanting hospital" and 12.4% for "population of residence". A total of 173 hospitals reported their data to the registry, representing a slight decrease compared with hospitals participating in 2017 (n=181). Conclusions: After the reduction in ICD implants in 2017, the number of implants increased in 2018, with the highest number of ICDs implanted in Spain. The total number of implants remains much lower than the European Union average, with substantial differences between autonomous communities

Spanish Implantable Cardioverter-defibrillator Registry. 15th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2018).

INTRODUCTION AND OBJECTIVES: This article presents the data corresponding to automated implantable cardioverter-defibrillator (ICD) implants in Spain reported to the Spanish Registry in 2018. METHODS: The data in this registry include both primary implants and generator replacements and were gathered from a data collection sheet voluntarily completed by implantation centers. RESULTS: In 2018, 6421 implant sheets were received compared with 7077 reported by Eucomed (European Confederation of Medical Suppliers Associations). This represents data on 90.7% of the devices implanted in Spain. Compliance ranged between 99.6% for the field "name of the implanting hospital" and 12.4% for "population of residence". A total of 173 hospitals reported their data to the registry, representing a slight decrease compared with hospitals participating in 2017 (n=181). CONCLUSIONS: After the reduction in ICD implants in 2017, the number of implants increased in 2018, with the highest number of ICDs implanted in Spain. The total number of implants remains much lower than the European Union average, with substantial differences between autonomous communities.

Registro Español de Desfibrilador Automático Implantable. XIV Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2017) / Spanish Implantable Cardioverter-defibrillator Registry. 14th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2017)

Introducción y objetivos: El Registro Español de Desfibrilador Automático aporta datos de actividad desde el año 2002. Métodos: Los datos de este registro provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos. Resultados: Durante 2017 se han recibido 6.273 hojas de implante, frente a las 6.429 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations); por lo tanto, se han recogido datos del 97,6% de los dispositivos implantados en España. El cumplimiento osciló entre el 99,7% en el campo «nombre del hospital implantador» y el 46,1% en la variable «clase funcional de la New York Heart Association». Comunicaron sus datos al registro 181 hospitales, lo que supone un aumento respecto a los que participaron en 2016 (177) y años anteriores (169 en 2015, 162 en 2014, 154 en 2013 o 153 en 2012). Conclusiones: Después de varios años de crecimiento en el número de implantes por millón de habitantes, este año se ha reducido. Como en los años previos, el número total de implantes en España sigue siendo muy inferior a la media de la Unión Europea, y la diferencia continúa aumentando, al igual que persisten las importantes diferencias entre comunidades autónomas españolas

Introduction and objectives: The Spanish Automatic Defibrillator Registry has provided activity data since 2002. Methods: The data in this registry are submitted by implantation centers that voluntarily complete a data collection sheet. Results: During 2017, a total of 6273 implant sheets were received, compared with 6429 reported by Eucomed (European Confederation of Medical Suppliers Associations). Therefore, the registry contains data on 97.6% of the devices implanted in Spain. Compliance ranged from 99.7% for the field "name of the implanting hospital " to 46.1% for the variable "New York Heart Association functional class ". A total of 181 hospitals reported data to the registry, representing an increase compared with the number of participating hospitals in 2016 (177) and in previous years (169 in 2015, 162 in 2014, 154 in 2013, and 153 in 2012). Conclusions: The number of implants per million inhabitants in Spain increased for several years but decreased in 2017. As in previous years, the total number of implants in Spain is still much lower than the European Union average, and the gap continues to widen. There are still substantial differences between autonomous communities

Spanish Implantable Cardioverter-defibrillator Registry. 14th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2017).

INTRODUCTION AND OBJECTIVES: The Spanish Automatic Defibrillator Registry has provided activity data since 2002. METHODS: The data in this registry are submitted by implantation centers that voluntarily complete a data collection sheet. RESULTS: During 2017, a total of 6273 implant sheets were received, compared with 6429 reported by Eucomed (European Confederation of Medical Suppliers Associations). Therefore, the registry contains data on 97.6% of the devices implanted in Spain. Compliance ranged from 99.7% for the field "name of the implanting hospital" to 46.1% for the variable "New York Heart Association functional class". A total of 181 hospitals reported data to the registry, representing an increase compared with the number of participating hospitals in 2016 (177) and in previous years (169 in 2015, 162 in 2014, 154 in 2013, and 153 in 2012). CONCLUSIONS: The number of implants per million inhabitants in Spain increased for several years but decreased in 2017. As in previous years, the total number of implants in Spain is still much lower than the European Union average, and the gap continues to widen. There are still substantial differences between autonomous communities.

Improvement in hemodynamic response using a quadripolar LV lead.

BACKGROUND: The Quartet quadripolar lead (St. Jude Medical Inc., St. Paul, MN, USA) offers 10 different left ventricle pacing configurations that may further influence hemodynamic parameters compared to traditional bipolar pacing configurations. The purpose of this study was to evaluate whether pacing from additional quadripolar lead vectors could enhance cardiac output (CO). METHODS: For each patient, CO was measured in "no-pacing" and in all the 10 configurations available, within 7 days of implantation of the device. Tip-ring, tip-right ventricular coil (RVC), and ring-RVC vectors were considered as traditional vectors. The seven additional configurations available in the quadripolar lead were considered as nontraditional vectors. CO was measured by ECHO. The best configuration was defined as the one presenting the highest CO measurement within configurations, which have a capture threshold <3 V and a safety margin between the capture and the phrenic nerve stimulation thresholds. RESULTS: Fifty-one standard cardiac resynchronization therapy patients were enrolled. The mean of each patient's best CO obtained with traditional vectors was higher than the baseline nonpaced CO (4.16 L/min vs 3.64 L/min). The mean of each patient's best CO, including all 10 available configurations, was also higher than the baseline nonpaced CO (4.33 L/min vs 3.64 L/min). In addition, the mean of each patient's best CO obtained with the best configuration available through a quadripolar lead was better than the mean of each patient's best CO obtained with a traditional configuration. In 53% of patients, the best CO was obtained with a nontraditional vector unique to the quadripolar lead. CONCLUSIONS: A quadripolar lead offers multiple additional pacing options to increase CO acutely compared to conventional bipolar leads.

Remodelado inverso ecocardiográfico y eléctrico en terapia de resincronización cardiaca / Echocardiographic and electrical reverse remodeling in cardiac resynchronization therapy

No disponible

Factors predicting and having an impact on the need for a permanent pacemaker after CoreValve prosthesis implantation using the new Accutrak delivery catheter system.

OBJECTIVES: The purpose of this study was to evaluate the need for a permanent pacemaker after transcatheter aortic valve implantation with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) using the new Accutrak delivery system (Medtronic, Inc.). BACKGROUND: The need for a permanent pacemaker is a recognized complication after transcatheter aortic valve implantation with the CoreValve prosthesis. METHODS: Between April 23, 2008 and May 31, 2011, 195 consecutive patients with symptomatic aortic valve stenosis underwent transcatheter aortic valve implantation using the self-expanding CoreValve prosthesis. In 124 patients, the traditional delivery system was used, and in 71 patients, the Accutrak delivery system was used. RESULTS: There were no significant differences in baseline electrocardiographic characteristics between the traditional system and the Accutrak patients: PR interval: 153 ± 46 mm versus 165 ± 30 mm, p = 0.12; left bundle branch block: 22 (20.2%) versus 8 (12.7%), p = 0.21; right bundle branch block: 21 (19.3%) versus 8 (12.7%), p = 0.26. The depth of the prosthesis in the left ventricular outflow tract was greater with the traditional system than with the Accutrak system (9.6 ± 3.2 mm vs. 6.4 ± 3 mm, p < 0.001) and the need for a permanent pacemaker was higher with traditional system than with Accutrak (35.1% vs. 14.3%, p = 0.003). The predictors of the need for a pacemaker were the depth of the prosthesis in the left ventricular outflow tract (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.08 to 1.34, p < 0.001), pre-existing right bundle branch block (HR: 3.5, 95% CI: 1.68 to 7.29, p = 0.001), and use of the traditional system (HR: 27, 95% CI: 2.81 to 257, p = 0.004). CONCLUSIONS: The new Accutrak delivery system was associated with less deep prosthesis implantation in the left ventricular outflow tract, which could be related to the lower rate of permanent pacemaker requirement.

Changes in atrioventricular conduction and predictors of pacemaker need after percutaneous implantation of the CoreValve®. Aortic valve prosthesis.

INTRODUCTION AND OBJECTIVES: Although changes in atrioventricular conduction frequently occur after percutaneous implantation of an aortic valve prosthesis, little is known about the mechanisms involved or how these changes progress. We investigated ECG abnormalities and predictors of pacemaker need after percutaneous implantation of the CoreValve® aortic valve prosthesis. METHODS: Between April 2008 and October 2009, 65 patients with symptomatic severe aortic stenosis received a CoreValve® prosthesis. Clinical and ECG parameters were recorded and predictors of pacemaker need due to advanced atrioventricular block were investigated. The analysis excluded three patients because they had pacemakers and a fourth who died during the procedure. RESULTS: The patients' mean age was 79 ± 7.8 years and their logistic EuroSCORE was 20 ± 14%. Implantation was successful in 98.4%. After implantation, 47.5% had left bundle branch block and 21 patients (34.4%) required a permanent pacemaker. The need for a pacemaker was associated with a greater depth of prosthesis implantation in the left ventricular outflow tract (LVOT): 13 ± 2.5 mm vs. 8.8 ± 2.8 mm (P< .001). Moreover, depth was the only predictor: odds ratio 1.9, 95% confidence interval 1.19-3.05 (P< .007). A cutpoint of 11.1 mm for the prosthesis depth in the LVOT had a sensitivity of 81% and a specificity of 84.6% for predicting the need for a pacemaker. CONCLUSIONS: After CoreValve® aortic valve prosthesis implantation, a high percentage of patients needed a permanent pacemaker for advanced atrioventricular block. The only independent predictor was the depth of the prosthesis in the LVOT, which could serve as an early indicator of pacemaker need.