Abstract 17820: The Impact Of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation On The Hemodynamic Profile And Prognosis Of Patients
Introduction: Conduction system abnormalities requiring the implantation of permanent pacemaker (PPM) consist a known complication of transcatheter aortic valve implantation (TAVI). Right ventricular pacing, in turn, may lead to desynchronization and reduced left ventricular ejection fraction (LVEF).
Hypothesis: We sought to investigate the possible hemodynamic and prognostic impact of PPM after TAVI.
Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2), who were scheduled for TAVI with a second-generation self-expanding valve, were consecutively enrolled. Clinical and echocardiographic data were prospectively collected before and after TAVI and were retrospectively analyzed in all patients. Left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (SPAP), and aortic, mitral, and tricuspid regurgitation grades were included in the analysis. The cumulative mortality, as a primary clinical end-point, was defined according to the criteria proposed by the Valve Academic Research Consortium-2.
Results: We included 174 patients (mean age: 80.0±6.8 years) in the study. The primary clinical end point occurred in 42 patients (23.6%) during a follow-up period of 24.8±20.4 months. The implantation of PPM was required in 77 patients (43.2%). Patients that did not receive PPM demonstrated significant improvement in LVEF (preLVEF: 49.8± 9.1% versus postLVEF: 51.0±8.5%, p<0.01) and SPAP (preSPAP: 45.7±13.3mmHg versus postSPAP: 42.3±9.6mmHg, p<0.01) after TAVI, while patients that received PPM demonstrated attenuated improvement in LVEF (preLVEF: 52.1± 8.7% versus postLVEF: 52.7±7.6%, p=0.21) and SPAP (preSPAP: 41.6± 10.5mmHg versus postSPAP: 40.0±8.8mmHg, p=0.13). The differences in post-TAVI aortic, mitral, and tricuspid regurgitation grades were insignificant. Mortality did not differ between patients that received PPM (20/77) and patients that did not (22/97) (25.9% versus 22.6%, p= 0.72)
Conclusions: Implantation of PPM after TAVI is associated with attenuated improvement in LVEF, without, however, affecting the clinical outcome.
- Aortic valve stenosis
- Percutaneous non-coronary cardiac intervention
- Transcatheter aortic valve implantation
Author Disclosures: M. Drakopoulou: None. K. Toutouzas: None. A. Michelongona: None. K. Stathogiannis: None. G. Latsios: None. A. Synetos: None. F. Mitropoulou: None. S. Sideris: None. E. Tsiamis: None. D. Tousoulis: None.
- © 2016 by American Heart Association, Inc.