Predictors of Need for Permanent Pacemaker Implantation and Conduction Abnormalities With a Novel Self-expanding Transcatheter Heart Valve

• Published in: Revista española de cardiología (English ed.) 2019-02, Vol.72 (2), p.145-153
• Main Authors: Pellegrini, Costanza, Husser, Oliver, Kim, Won-Keun, Holzamer, Andreas, Walther, Thomas, Rheude, Tobias, Mayr, Nicola Patrick, Trenkwalder, Teresa, Joner, Michael, Michel, Jonathan, Chaustre, Fabian, Kastrati, Adnan, Schunkert, Heribert, Burgdorf, Christof, Hilker, Michael, Möllmann, Helge, Hengstenberg, Christian
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Atrioventricular Block - therapy; Bradycardia - therapy; Bundle-Branch Block; Cardiac Conduction System Disease - therapy; Cardiac Pacing, Artificial - statistics & numerical data; Cardiovascular; Electrocardiography; Female; Humans; Internal Medicine; Male; Needs Assessment; Pacemaker, Artificial; Prospective Studies; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2018.01.011

Abstract Introduction and objectives The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). Methods Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232). Results A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 ± 1.9 vs 7.1 ± 1.5 mm; P = .6 and 41.0 ± 7.9 vs 42.2 ± 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013). Conclusions New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors.