Factors predicting and having an impact on the need for a permanent pacemaker after CoreValve prosthesis implantation using the new Accutrak delivery catheter system.
JACC Cardiovasc Interv
; 5(5): 533-539, 2012 May.
Article
in En
| MEDLINE
| ID: mdl-22625192
ABSTRACT
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Aortic Valve Stenosis
/
Pacemaker, Artificial
/
Bundle-Branch Block
/
Heart Valve Prosthesis
/
Cardiac Catheterization
/
Cardiac Pacing, Artificial
/
Heart Valve Prosthesis Implantation
/
Catheters
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
En
Journal:
JACC Cardiovasc Interv
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2012
Document type:
Article