Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-06-2018

Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement

Authors: Derek Leong, Ali A. Sovari, Ashkan Ehdaie, Tarun Chakravarty, Qiang Liu, Hasan Jilaihawi, Rajendra Makkar, Xunzhang Wang, Eugenio Cingolani, Michael Shehata

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2018

Abstract

Background

Damage to the cardiac conduction system requiring permanent pacemaker (PPM) implantation is a known adverse outcome of transcatheter aortic valve replacement (TAVR). A permanent-temporary pacemaker (PTPM) is a device that involves an active-fixation lead attached to an external pulse generator taped to the skin. We reviewed the utility of PTPMs as a temporary bridge measure after TAVR in patients with conduction abnormalities that do not meet conventional criteria for PPM placement.

Methods

Between January 01, 2013 and December 31, 2015, we analyzed 67 patients who received PTPM after TAVR. Baseline demographics, comorbidities, type and size of the valve, pre-TAVR electrocardiograms (ECGs), post-TAVR ECGs at 1 day, 1 month, and 6 months, and pacemaker interrogation results were reviewed for each patient if available.

Results

The mean age of patients was 80.5 ± 9.1 years. PTPM were placed for 2.3 ± 2.4 days. Among these patients, 44.8% (n = 30) received a PPM prior to discharge. Male gender (OR 2.84, 95% CI 1.05–7.69, p = 0.05) and an increase in QRS duration post-TAVR (p = 0.01) were associated with PPM placement. Pacemaker interrogation data of 11 patients with PPM revealed that 27% (n = 3) had < 1% V-pacing requirements and < 10% A-pacing requirements.

Conclusions

In post-TAVR patients who develop conduction abnormalities that do not meet conventional PPM implantation indications, PTPM safely provides a time period for further assessment and may prevent unnecessary PPM implantation. Male gender and an increase in QRS duration post-TAVR are associated with PPM implantation. Additionally, some patients may recover from their conduction disturbances and demonstrate low pacemaker utilization.

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. https://doi.org/10.1056/NEJMoa1008232.CrossRefPubMed

Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20. https://doi.org/10.1056/NEJMoa1514616.CrossRefPubMed

Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. https://doi.org/10.1056/NEJMoa1103510.CrossRefPubMed

Walther T, Hamm CW, Schuler G, Berkowitsch A, Kotting J, Mangner N, et al. Perioperative results and complications in 15,964 transcatheter aortic valve replacements. Prospective Data From the GARY Registry J Am Coll Cardiol. 2015;65(20):2173–80. https://doi.org/10.1016/j.jacc.2015.03.034.CrossRefPubMed

Genereux P, Head SJ, Van Mieghem NM, Kodali S, Kirtane AJ, Xu K, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol. 2012;59(25):2317–26. https://doi.org/10.1016/j.jacc.2012.02.022.CrossRefPubMed

Webb JG, Altwegg L, Boone RH, Cheung A, Ye J, Lichtenstein S, et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009;119(23):3009–16. https://doi.org/10.1161/CIRCULATIONAHA.108.837807.CrossRefPubMed

Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014;63(19):1972–81. https://doi.org/10.1016/j.jacc.2014.02.556.CrossRefPubMed

Meredith Am IT, Walters DL, Dumonteil N, Worthley SG, Tchetche D, Manoharan G, et al. Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study. J Am Coll Cardiol. 2014;64(13):1339–48. https://doi.org/10.1016/j.jacc.2014.05.067.CrossRefPubMed

Siontis GC, Juni P, Pilgrim T, Stortecky S, Bullesfeld 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. https://doi.org/10.1016/j.jacc.2014.04.033.CrossRefPubMed

10.

Nazif TM, Dizon JM, Hahn RT, Xu K, Babaliaros V, Douglas PS, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):60–9. https://doi.org/10.1016/j.jcin.2014.07.022.CrossRefPubMed

11.

Guetta V, Goldenberg G, Segev A, Dvir D, Kornowski R, Finckelstein A, et al. Predictors and course of high-degree atrioventricular block after transcatheter aortic valve implantation using the CoreValve Revalving System. Am J Cardiol. 2011;108(11):1600–5. https://doi.org/10.1016/j.amjcard.2011.07.020.CrossRefPubMed

12.

Sovari AA, Shehata M. Heart block following transcatheter aortic valve implantation: a matter of right bundle branch integrity? Expert Rev Cardiovasc Ther. 2016;14(6):663–5. https://doi.org/10.1586/14779072.2016.1168694.CrossRefPubMed

13.

Haworth P, Behan M, Khawaja M, Hutchinson N, de Belder A, Trivedi U, et al. Predictors for permanent pacing after transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2010;76(5):751–6. https://doi.org/10.1002/ccd.22457.CrossRefPubMed

14.

Roten L, Wenaweser P, Delacretaz E, Hellige G, Stortecky S, Tanner H, et al. Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation. Am J Cardiol. 2010;106(10):1473–80. https://doi.org/10.1016/j.amjcard.2010.07.012.CrossRefPubMed

15.

De Carlo M, Giannini C, Bedogni F, Klugmann S, Brambilla N, De Marco F, et al. Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation. Am Heart J. 2012;163(3):492–9. https://doi.org/10.1016/j.ahj.2011.12.009.CrossRefPubMed

16.

Erkapic D, Kim WK, Weber M, Mollmann H, Berkowitsch A, Zaltsberg S, et al. Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. Europace. 2010;12(8):1188–90. https://doi.org/10.1093/europace/euq094.CrossRefPubMed

17.

Boerlage-Van Dijk K, Kooiman KM, Yong ZY, Wiegerinck EM, Damman P, Bouma BJ, et al. Predictors and permanency of cardiac conduction disorders and necessity of pacing after transcatheter aortic valve implantation. Pacing Clin Electrophysiol. 2014;37(11):1520–9. https://doi.org/10.1111/pace.12460.CrossRefPubMed

18.

Lever N, Ferguson JD, Bashir Y, Channon KM. Prolonged temporary cardiac pacing using subcutaneous tunnelled active-fixation permanent pacing leads. Heart. 2003;89(2):209–10.CrossRefPubMedPubMedCentral

19.

Kornberger A, Schmid E, Kalender G, Stock UA, Doernberger V, Khalil M, et al. Bridge to recovery or permanent system implantation: an eight-year single-center experience in transvenous semipermanent pacing. Pacing Clin Electrophysiol. 2013;36(9):1096–103. https://doi.org/10.1111/pace.12175.CrossRefPubMed

20.

Braun MU, Rauwolf T, Bock M, Kappert U, Boscheri A, Schnabel A, et al. Percutaneous lead implantation connected to an external device in stimulation-dependent patients with systemic infection--a prospective and controlled study. Pacing Clin Electrophysiol. 2006;29(8):875–9. https://doi.org/10.1111/j.1540-8159.2006.00454.x.CrossRefPubMed

21.

Dawood FZ, Boerkircher A, Rubery B, Hire D, Soliman EZ. Risk of early mortality after placement of a temporary-permanent pacemaker. J Electrocardiol. 2016;49(4):530–5. https://doi.org/10.1016/j.jelectrocard.2016.05.004.CrossRefPubMed

22.

Zei PC, Eckart RE, Epstein LM. Modified temporary cardiac pacing using transvenous active fixation leads and external re-sterilized pulse generators. J Am Coll Cardiol. 2006;47(7):1487–9. https://doi.org/10.1016/j.jacc.2006.01.006.CrossRefPubMed

23.

de Cock CC, Van Campen CM, In't Veld JA, Visser CA. Utility and safety of prolonged temporary transvenous pacing using an active-fixation lead: comparison with a conventional lead. Pacing Clin Electrophysiol. 2003;26(5):1245–8.CrossRefPubMed

24.

Chihrin SM, Mohammed U, Yee R, Gula LJ, Klein GJ, Skanes AC, et al. Utility and cost effectiveness of temporary pacing using active fixation leads and an externally placed reusable permanent pacemaker. Am J Cardiol. 2006;98(12):1613–5. https://doi.org/10.1016/j.amjcard.2006.07.041.CrossRefPubMed

25.

Steinberg JS, Fischer A, Wang P, Schuger C, Daubert J, McNitt S, et al. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II. J Cardiovasc Electrophysiol. 2005;16(4):359–65. https://doi.org/10.1046/j.1540-8167.2005.50038.x.CrossRefPubMed

26.

Barsheshet A, Moss AJ, McNitt S, Jons C, Glikson M, Klein HU, et al. Long-term implications of cumulative right ventricular pacing among patients with an implantable cardioverter-defibrillator. Heart Rhythm. 2011;8(2):212–8. https://doi.org/10.1016/j.hrthm.2010.10.035.CrossRefPubMed

27.

Dizon JM, Nazif TM, Hess PL, Biviano A, Garan H, Douglas PS, et al. Chronic pacing and adverse outcomes after transcatheter aortic valve implantation. Heart. 2015;101(20):1665–71. https://doi.org/10.1136/heartjnl-2015-307666.CrossRefPubMed

28.

Urena M, Webb JG, Eltchaninoff H, Munoz-Garcia AJ, Bouleti C, Tamburino C, et al. Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death. J Am Coll Cardiol. 2015;65(5):437–48. https://doi.org/10.1016/j.jacc.2014.11.027.CrossRefPubMed

29.

Mouillet G, Lellouche N, Lim P, Meguro K, Yamamoto M, Deux JF, et al. Patients without prolonged QRS after TAVI with CoreValve device do not experience high-degree atrio-ventricular block. Catheter Cardiovasc Interv. 2013;81(5):882–7. https://doi.org/10.1002/ccd.24657.CrossRefPubMed

30.

van der Boon RM, Van Mieghem NM, Theuns DA, Nuis RJ, Nauta ST, Serruys PW, et al. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System. Int J Cardiol. 2013;168(2):1269–73. https://doi.org/10.1016/j.ijcard.2012.11.115.CrossRefPubMed

31.

Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, O'Regan DJ, et al. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2013;17(2):328–33. https://doi.org/10.1093/icvts/ivt175.CrossRefPubMedPubMedCentral

Title: Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement
Authors: Derek Leong
Ali A. Sovari
Ashkan Ehdaie
Tarun Chakravarty
Qiang Liu
Hasan Jilaihawi
Rajendra Makkar
Xunzhang Wang
Eugenio Cingolani
Michael Shehata
Publication date: 01-06-2018
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-018-0345-z

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Precision of automated QRS duration measurement in patients treated with cardiac resynchronization therapy

Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials

Cardiac resynchronization therapy response in heart failure patients with different subtypes of true left bundle branch block

Percutaneous Left Atrial Appendage Closure with WATCHMAN™ device: peri-procedural and mid-term outcomes from the TRAPS Registry

Improving sudden cardiac death risk stratification by evaluating electrocardiographic measures of global electrical heterogeneity and clinical outcomes among patients with implantable cardioverter-defibrillators: rationale and design for a retrospective, multicenter, cohort study

Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation—the protective role of antiarrhythmic drug therapy

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page