Register
Forgot your password?

Predictors of pacemaker implantation after transcatheter aortic valve implantation

Authors: Dzhidzalova D.Kh., Berdibekov B.Sh., Bulaeva N.I., Petrosian K.V., Mrikaev D.V., Kudryashova E.N., Efendieva A.S., Abgaryan A.A., Romanchuk D.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-4-525-535

For citation: Dzhidzalova D.Kh., Berdibekov B.Sh., Bulaeva N.I., Petrosian K.V., Mrikaev D.V., Kudryashova E.N., Efendieva A.S., Abgaryan A.A., Romanchuk D.V., Golukhova E.Z. Predictors of pacemaker implantation after transcatheter aortic valve implantation. Creative Cardiology. 2023; 17 (4): 525–35 (in Russ.). DOI: 10.24022/1997-3187-2023-17-4-525-535

Received / Accepted:  10.11.2023 / 20.11.2023

Keywords: aortic stenosis transcatheter aortic valve implantation pacemaker right bundle branch block atrioventricular block

Download
Full text:  

 

Abstract

Objective. To assess the incidence of cardiac conduction disorders associated with transcatheter aortic valve implantation (TAVI) and identification of predictors of the need for permanent cardiac pacing (PCP) in the early postoperative period.

Material and methods. A prospective single-center study included 70 patients with symptomatic severe aortic stenosis who underwent the procedure TAVI. The average age of the patients was 75.1±6.8 years, most of them were women (67.1%). To determine cardiac conduction disorders all patients underwent electrocardiogram registration before and after TAVI. Univariate and multivariate regression analyzes were used to determine the factors influencing the need for PCP after TAVI.

Results. Statistically significant prolongation of the duration of the QRS complex (p=0.009) and QT (p=0.026) after TAVI was established as a result of the analysis. Third degree atrioventricular block was significantly more common (0.0 versus 2.9%, р=0.031) in the postoperative period, therefore the need for pacemaker implantation occurred more often (4.3 versus 14.3%, р=0.0016). Predictors such as female sex, left ventricular (LV) ejection fraction, LV end-diastolic volume, LV end-systolic volume, prolongation of PQ intervals and QRS duration, and baseline right bundle branch block (RBBB) by univariate regression analysis were associated with pacemaker implantation after TAVI during the hospital period. As a result of multivariate regression analysis, the independent predictor associated with pacemaker implantation during the hospital period after TAVI was the presence of RBBB (odds ratio 11.38; 95% confidence interval 1.13–114.08; p=0.039).

Conclusion. As a result of the study, it was revealed that the only independent predictor of PCP after TAVI in the hospital period is the presence of initial RBBB.

References

  1. Leon M.B., Smith C.R., Mack M., Miller D.C., Moses J.W., Svensson L.G. et al. PARTNER trial investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010; 363 (17): 1597– 607. DOI: 10.1056/NEJMoa1008232
  2. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K. et al. PARTNER 2 investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 2016; 374 (17): 1609–20. DOI: 10.1056/NEJMoa1514616
  3. Thyregod H.G., Steinbrüchel D.A., Ihlemann N., Nissen H., Kjeldsen B.J., Petursson P. et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J. Am. Coll. Cardiol. 2015; 65 (20): 2184–94. DOI: 10.1016/j.jacc.2015.03.014
  4. Mack M.J., Leon M.B., Thourani V.H., Makkar R., Kodali S.K., Russo M. et al. PARTNER 3 Investigators. Transcatheter aorticvalve replacement with a balloon-expandable valve in lowrisk patients. N. Engl. J. Med. 2019; 380 (18): 1695–705. DOI: 10.1056/NEJMoa1814052
  5. Levack M.M., Kapadia S.R., Soltesz E.G., Gillinov A.M., Houghtaling P.L., Navia J.L. et al. Prevalence of and risk factors for permanent pacemaker implantation after aortic valve replacement. Ann. Thorac. Surg. 2019; 108 (3): 700–7. DOI: 10.1016/j.athoracsur.2019.03.056
  6. Hamdan A., Guetta V., Klempfner R., Konen E., Raanani E., Glikson M. et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc. Interv. 2015; 8 (9): 1218–28. DOI: 10.1016/j.jcin.2015.05.010
  7. Moreno R., Dobarro D., López de Sá E., Prieto M., Morales C., Calvo Orbe L. et al. Cause of complete atrioventricular block after percutaneous aortic valve implantation: insights from a necropsy study. Circulation. 2009; 120 (5): e29–30. DOI: 10.1161/CIRCULATIONAHA.109.849281
  8. Glikson M., Nielsen J.C., Kronborg M.B., Michowitz Y., Auricchio A., Barbash I.M. et al. ESC scientific document group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur. Heart J. 2021; 42 (35): 3427– 520. DOI: 10.1093/eurheartj/ehab364
  9. 2021 ESC/EACTS guidelines for the management of patients with valvular heart disease. Russian Journal of Cardiology. 2022; 27 (7): 5160. DOI: 10.15829/1560-4071-2022-5160
  10. Smith C.R., Leon M.B., Mack M.J., Miller D.C., Moses J.W., Svensson L.G. et al. PARTNER trial investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011; 364 (23): 2187–98. DOI: 10.1056/NEJMoa1103510
  11. Gilard M., Eltchaninoff H., Iung B., Donzeau-Gouge P., Chevreul K., Fajadet J. et al. FRANCE 2 investigators. Registry of transcatheter aortic-valve implantation in high-risk patients. N. Engl. J. Med. 2012; 366 (18): 1705–15. DOI: 10.1056/NEJMoa1114705
  12. Mack M.J., Leon M.B., Thourani V.H., Makkar R., Kodali S.K., Russo M. et al. PARTNER 3 investigators. Transcatheter aorticvalve replacement with a balloon-expandable valve in lowrisk patients. N. Engl. J. Med. 2019; 380 (18): 1695–705. DOI: 10.1056/NEJMoa1814052
  13. Thomas M., Schymik G., Walther T., Himbert D., Lefèvre T., Treede H. et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2010; 122 (1): 62–9. DOI: 10.1161/CIRCULATIONAHA.109.907402
  14. Bockeria L.A., Berishvili I.I. (Eds.) Surgical anatomy of the heart in 3 vol. Vol. 1. Normal heart and blood circulation physiology. Moscow; 2006.
  15. Siontis G.C., Jüni P., Pilgrim T., Stortecky S., Büllesfeld L., Meier B. et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J. Am. Coll. Cardiol. 2014; 64 (2): 129–40. DOI: 10.1016/j.jacc.2014.04.033
  16. Sammour Y., Krishnaswamy A., Kumar A., Puri R., Tarakji K.G., Bazarbashi N. et al. Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement. JACC Cardiovasc. Interv. 2021; 14 (2): 115– 34. DOI: 10.1016/j.jcin.2020.09.063
  17. Mahajan S., Gupta R., Malik A.H., Mahajan P., Aedma S.K., Aronow W.S. et al. Predictors of permanent pacemaker insertion after TAVR: a systematic review and updated meta-analysis. J. Cardiovasc. Electrophysiol. 2021; 32 (5): 1411–20. DOI: 10.1111/jce.14986
  18. Chorianopoulos E., Krumsdorf U., Pleger S.T., Katus H.A., Bekeredjian R. Incidence of late occurring bradyarrhythmias after TAVI with the self-expanding CoreValve(®) aortic bioprosthesis. Clin. Res. Cardiol. 2012; 101 (5): 349–55. DOI: 10.1007/s00392-011-0398-9
  19. Egger F., Nürnberg M., Rohla M., Weiss T.W., Unger G., Smetana P. High-degree atrioventricular block in patients with preexisting bundle branch block or bundle branch block occurring during transcatheter aortic valve implantation. Heart Rhythm. 2014; 11 (12): 2176–82. DOI: 10.1016/j.hrthm.2014.07.014
  20. Waksman R., Steinvil A. Pre-transcatheter aortic valve replacement right bundle branch block: a bundle of trouble. JACC Cardiovasc. Interv. 2017; 10 (15): 1575–7. DOI: 10.1016/j.jcin.2017.06.012
  21. Ullah W., Zahid S., Zaidi S.R., Sarvepalli D., Haq S., Roomi S. et al. Predictors of permanent pacemaker implantation in patients undergoing transcatheter aortic valve replacement – a systematic review and meta-analysis. J. Am. Heart Assoc. 2021; 10 (14): e020906. DOI: 10.1161/JAHA.121.020906
  22. Watanabe Y., Kozuma K., Hioki H., Kawashima H., Nara Y., Kataoka A. et al. Pre-existing right bundle branch block increases risk for death after transcatheter aortic valve replacement with a balloon-expandable valve. JACC Cardiovasc. Interv. 2016; 9 (21): 2210–6. DOI: 10.1016/j.jcin.2016.08.035
  23. Auffret V., Webb J.G., Eltchaninoff H., Muñoz-García A.J., Himbert D., Tamburino C. et al. Clinical impact of baseline right bundle branch block in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc. Interv. 2017; 10 (15): 1564–74. DOI: 10.1016/j.jcin.2017.05.030
  24. Sammour Y., Sato K., Kumar A., Gajulapalli R.D., Lak H., Chawla S. et al. Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3. Catheter. Cardiovasc. Interv. 2021; 98 (1): E127–38. DOI: 10.1002/ccd.29309
  25. 2021 ESC Guidelines on Pacing and Cardiac Resynchronization Therapy. Russian Journal of Cardiology. 2022; 27 (7): 5159. DOI: 10.15829/1560-4071-2022-5159
  26. Lilly S.M., Deshmukh A.J., Epstein A.E., Ricciardi M.J., Shreenivas S., Velagapudi P., Wyman J.F. 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American College of Cardiology solution set oversight committee. J. Am. Coll. Cardiol. 2020; 76 (20): 2391–411. DOI: 10.1016/j.jacc.2020.08.050
  27. Junquera L., Freitas-Ferraz A.B., Padrón R., Silva I., Nunes Ferreira-Neto A., Guimaraes L. et al. Intraprocedural high-degree atrioventricular block or complete heart block in transcatheter aortic valve replacement recipients with no prior intraventricular conduction disturbances. Catheter. Cardiovasc. Interv. 2020; 95 (5): 982–90. DOI: 10.1002/ccd.28323

About Authors

  • Diana Kh. Dzhidzalova, Cardiologist; ORCID
  • Bektur Sh. Berdibekov, Junior Researcher, Cardiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Associate Professor, Head of Department, Cardiologist; ORCID
  • Karen V. Petrosian, Dr. Med. Sci., Endovascular Surgeon, Head of Department; ORCID
  • David V. Mrikaev, Cand. Med. Sci., Cardiologist; ORCID
  • Elena N. Kudryashova, Cardiologist; ORCID
  • Anastasiya S. Efendieva, Postgraduate; ORCID
  • Anna A. Abgaryan, Postgraduate; ORCID
  • Denis V. Romanchuk, Postgraduate; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by