Predictors and Clinical Outcomes of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement The PARTNER (Placement of AoRtic TraNscathetER Valves) Trial and Registry

被引：443

作者：

Nazif, Tamim M. ^{[1
]}

Dizon, Jose M. ^{[1
]}

Hahn, Rebecca T. ^{[1
]}

Xu, Ke ^{[2
]}

Babaliaros, Vasilis ^{[3
]}

Douglas, Pamela S. ^{[4
]}

El-Chami, Mikhael F. ^{[3
]}

Herrmann, Howard C. ^{[5
]}

Mack, Michael ^{[6
]}

Makkar, Raj R. ^{[7
]}

Miller, Craig ^{[8
]}

Pichard, Augusto ^{[9
]}

Tuzcu, E. Murat ^{[10
]}

Szeto, Wilson Y. ^{[5
]}

Webb, John G. ^{[11
]}

Moses, Jeffrey W. ^{[1
]}

Smith, Craig R. ^{[1
]}

Williams, Mathew R. ^{[1
]}

Leon, Martin B. ^{[1
]}

Kodali, Susheel K. ^{[1
]}

机构：

[1] Columbia Univ, Med Ctr, New York, NY 10032 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] Emory Univ, Sch Med, Atlanta, GA USA

[4] Duke Clin Res Inst, Durham, NC USA

[5] Hosp Univ Penn, Philadelphia, PA 19104 USA

[6] Baylor Healthcare Syst, Plano, TX USA

[7] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[8] Stanford Univ, Sch Med, Stanford, CA 94305 USA

[9] Medstar Washington Hosp Ctr, Washington, DC USA

[10] Cleveland Clin, Cleveland, OH 44106 USA

[11] St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2015年 / 8卷 / 01期

关键词：

cardiac conduction; pacemaker; PARTNER; TAVR; transcatheter aortic valve replacement; BUNDLE-BRANCH BLOCK; CARDIAC RESYNCHRONIZATION; ATRIOVENTRICULAR-BLOCK; MEDTRONIC-COREVALVE; HEART-FAILURE; CONDUCTION DISORDERS; ELDERLY-PATIENTS; EDWARDS-SAPIEN; IMPACT; RISK;

D O I：

10.1016/j.jcin.2014.07.022

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES The purpose of this study was to identify predictors and clinical implications of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). BACKGROUND Cardiac conduction disturbances requiring PPM are a frequent complication of TAVR. However, limited data is available regarding this complication after TAVR with a balloon-expandable valve. METHODS The study included patients without prior pacemaker who underwent TAVR in the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry and investigated predictors and clinical effect of new PPM. RESULTS Of 2,559 TAVR patients, 586 were excluded due to pre-existing PPM. A new PPM was required in 173 of the remaining 1,973 patients (8.8%). By multivariable analysis, predictors of PPM included right bundle branch block (odds ratio [OR]: 7.03, 95% confidence interval [CI]: 4.92 to 10.06, p < 0.001), prosthesis diameter/left ventricular (LV) outflow tract diameter (for each 0.1 increment, OR: 1.29, 95% CI: 1.10 to 1.51, p = 0.002), LV end-diastolic diameter (for each 1 cm, OR: 0.68, 95% CI: 0.53 to 0.87, p = 0.003), and treatment in continued access registry (OR: 1.77, 95% CI: 1.08 to 2.92, p = 0.025). Patients requiring PPM had a longer mean duration of post-procedure hospitalization (7.3 +/- 2.7 days vs. 6.2 +/- 2.8 days, p = 0.001). At 1 year, new PPM was associated with significantly higher repeat hospitalization (23.9% vs. 18.2%, p = 0.05) and mortality or repeat hospitalization (42.0% vs. 32.6%, p = 0.007). There was no difference between groups in LV ejection fraction at 1 year. CONCLUSIONS PPM was required in 8.8% of patients without prior PPM who underwent TAVR with a balloon-expandable valve in the PARTNER trial and registry. In addition to pre-existing right bundle branch block, the prosthesis to LV outflow tract diameter ratio and the LV end-diastolic diameter were identified as novel predictors of PPM after TAVR. New PPM was associated with a longer duration of hospitalization and higher rates of repeat hospitalization and mortality or repeat hospitalization at 1 year. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：60 / 69

页数：10

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