Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 +/- 6 years, 58% males, EuroSCORE: 7.8 +/- 3.3%, STS mortality score: 5 +/- 2.8%). Pacemaker interrogations within 4-6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 +/- 50 to 230 +/- 51, p = 0.02; QRS interval from 124 +/- 23 to 147 +/- 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.

Pinnacchio, G., Ruscio, E., Rocco, E., Trani, C., Burzotta, F., Aurigemma, C., Romagnoli, E., Scacciavillani, R., Narducci, M. L., Bencardino, G., Perna, F., Spera, F. R., Comerci, G., Bisignani, A., Pelargonio, G., Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation, <<JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE>>, 2022; 9 (10): 324-N/A. [doi:10.3390/jcdd9100324] [https://hdl.handle.net/10807/221872]

Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

Pinnacchio, Gaetano;Trani, Carlo;Burzotta, Francesco;Aurigemma, Cristina;Scacciavillani, Roberto;Narducci, Maria Lucia;Bencardino, Gianluigi;Perna, Francesco;Comerci, Gianluca;Bisignani, Antonio;Pelargonio, Gemma
2022

Abstract

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 +/- 6 years, 58% males, EuroSCORE: 7.8 +/- 3.3%, STS mortality score: 5 +/- 2.8%). Pacemaker interrogations within 4-6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 +/- 50 to 230 +/- 51, p = 0.02; QRS interval from 124 +/- 23 to 147 +/- 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.
Inglese
Pinnacchio, G., Ruscio, E., Rocco, E., Trani, C., Burzotta, F., Aurigemma, C., Romagnoli, E., Scacciavillani, R., Narducci, M. L., Bencardino, G., Perna, F., Spera, F. R., Comerci, G., Bisignani, A., Pelargonio, G., Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation, <<JOURNAL OF CARDIOVASCULAR DEVELOPMENT AND DISEASE>>, 2022; 9 (10): 324-N/A. [doi:10.3390/jcdd9100324] [https://hdl.handle.net/10807/221872]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/221872
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