Top

Published in:

01-11-2015 | Original Paper

Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR

Authors: Marcel Weber, Eva Brüggemann, Robert Schueler, Diana Momcilovic, Jan-Malte Sinning, Alexander Ghanem, Nikos Werner, Eberhard Grube, Wolfgang Schiller, Fritz Mellert, Armin Welz, Georg Nickenig, Christoph Hammerstingl

Published in: Clinical Research in Cardiology | Issue 11/2015

Abstract

Background

Left ventricular conduction disturbances (VCD) with or without need for pacemaker (PM) implantation are common after transcatheter aortic valve replacement (TAVR). Its effect on patients’ functional recovery after TAVR is unclear.

Methods and results

212 patients (Age 80.8 ± 6.4 years, logEuroscore 28.95 ± 17.37 %) underwent TAVR with the self-expanding CoreValve prosthesis and completed 9-month follow-up (FU). After TAVR 125 (59 %) patients were diagnosed with VCD. This group consists of 41 (19 %) patients with a new PM after TAVR, 33 (16 %) patients with PM prior TAVR and markedly increased ventricular stimulation rate, 48 (23 %) patients with new LBBB post-TAVR and three (1 %) patients with LBBB prior TAVR. After FU, the presence of VCD alone was associated with worse recovery of left ventricular ejection fraction (LVEF) (VCD: LVEF_baseline 51.7 ± 18.2 %, LVEF_FU 53.9 ± 13.0 %; p = 0.8; noVCD: LVEF_baseline 53.8 ± 12.9 %, LVEF_FU 63.4 ± 10.1 %; p < 0.01) but had no impact on functional outcomes after TAVR (p > 0.05). Especially patients with VCD caused by permanent RV pacing showed worse functional outcomes presenting with higher functional NYHA classes (p < 0.05), and higher NT-proBNP levels (p < 0.05). 20.4 % of patients with need for PM after TAVR remained in NYHA class ≥3, as compared to 5 % of patients without PM (VCD but no PM: 4.7 %, p < 0.001; noVCD: 5.3 %, p < 0.001). VCD with or without need for PM had no impact on survival after FU.

Conclusion

The occurrence of VCD after TAVR is common and associated with unfavorable left ventricular functional recovery. However, only the combination of VCD with permanent right ventricular pacing has adverse impact on heart failure-related symptoms after TAVR.

Pai RG, Varadarajan P, Razzouk A (2008) Survival benefit of aortic valve replacement in patients with severe aortic stenosis with low ejection fraction and low gradient with normal ejection fraction. Ann Thorac Surg 86(6):1781–1789 S0003-4975(08)01670-6 CrossRefPubMed

El-Mawardy M, Wubken-Kleinfeld N, Schwarz B, Gordian K, Stocker B, Sier H, Toelg R, Geist V, Kraatz EG, Richardt G, Abdel-Wahab M (2014) Transcatheter aortic valve implantation in patients with severely reduced left ventricular systolic function: a single-center experience. Clin Res Cardiol 103(8):621–630. doi:10.1007/s00392-014-0691-5 CrossRefPubMed

Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106(24):3006–3008CrossRefPubMed

Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198. doi:10.1056/NEJMoa1103510 CrossRefPubMed

Sedaghat A, Sinning JM, Vasa-Nicotera M, Ghanem A, Hammerstingl C, Grube E, Nickenig G, Werner N (2013) The revised EuroSCORE II for the prediction of mortality in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 102(11):821–829. doi:10.1007/s00392-013-0596-8 CrossRefPubMed

Beller CJ, Schmack B, Seppelt P, Arif R, Bekeredjian R, Krumsdorf U, Katus HA, Karck M, Kallenbach K (2013) The groin first approach for transcatheter aortic valve implantation: are we pushing the limits for transapical implantation? Clin Res Cardiol 102(2):111–117. doi:10.1007/s00392-012-0502-9 CrossRefPubMed

Puls M, Viel T, Danner BC, Jacobshagen C, Teucher N, Hanekop G, Schondube F, Hasenfuss G, Seipelt RG, Schillinger W (2012) The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts: a single-centre experience. Clin Res Cardiol 101(7):553–563. doi:10.1007/s00392-012-0426-4 PubMedCentralCrossRefPubMed

Haussig S, Schuler G, Linke A (2014) Worldwide TAVI registries: what have we learned? Clin Res Cardiol 103(8):603–612. doi:10.1007/s00392-014-0698-y CrossRefPubMed

O’Sullivan CJ, Stortecky S, Buellesfeld L, Wenaweser P, Windecker S (2014) Preinterventional screening of the TAVI patient: how to choose the suitable patient and the best procedure. Clin Res Cardiol 103(4):259–274. doi:10.1007/s00392-014-0676-4 CrossRefPubMed

10.

Bagur R, Rodes-Cabau J, Dumont E, Larochelliere RD, Doyle D, Bertrand OF, Cote M, Poirier P, Pibarot P (2011) Exercise capacity in patients with severe symptomatic aortic stenosis before and six months after transcatheter aortic valve implantation. Am J Cardiol 108(2):258–264. doi:10.1016/j.amjcard.2011.03.031 CrossRefPubMed

11.

Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G, Klugmann S, Bedogni F, Maisano F, Marzocchi A, Poli A, Antoniucci D, Napodano M, De Carlo M, Fiorina C, Ussia GP (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123(3):299–308. doi:10.1161/CIRCULATIONAHA.110.946533 CrossRefPubMed

12.

Moat NE, Ludman P, de Belder MA, Bridgewater B, Cunningham AD, Young CP, Thomas M, Kovac J, Spyt T, MacCarthy PA, Wendler O, Hildick-Smith D, Davies SW, Trivedi U, Blackman DJ, Levy RD, Brecker SJ, Baumbach A, Daniel T, Gray H, Mullen MJ (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 58(20):2130–2138. doi:10.1016/j.jacc.2011.08.050 CrossRefPubMed

13.

Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, Naber C, Voehringer M, Schafer U, Senges J, Richardt G (2012) Transcatheter aortic valve implantation in patients with and without concomitant coronary artery disease: comparison of characteristics and early outcome in the German multicenter TAVI registry. Clin Res Cardiol 101(12):973–981. doi:10.1007/s00392-012-0486-5 CrossRefPubMed

14.

Khatri PJ, Webb JG, Rodes-Cabau J, Fremes SE, Ruel M, Lau K, Guo H, Wijeysundera HC, Ko DT (2013) Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med 158(1):35–46CrossRefPubMed

15.

Piazza N, Onuma Y, Jesserun E, Kint PP, Maugenest A-M, Anderson RH, de Jaegere PPT, Serruys PW (2008) Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. J Am Coll Cardiol Intv 1(3):310–316. doi:10.1016/j.jcin.2008.04.007 CrossRef

16.

Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, Spence MS, Brown S, Khan SQ, Walker N, Trivedi U, Hutchinson N, De Belder AJ, Moat N, Blackman DJ, Levy RD, Manoharan G, Roberts D, Khogali SS, Crean P, Brecker SJ, Baumbach A, Mullen M, Laborde JC, Hildick-Smith D (2011) Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation 123(9):951–960. doi:10.1161/CIRCULATIONAHA.109.927152 CrossRefPubMed

17.

Martinez-Selles M, Bramlage P, Thoenes M, Schymik G (2015) Clinical significance of conduction disturbances after aortic valve intervention: current evidence. Clin Res Cardiol 104(1):1–12. doi:10.1007/s00392-014-0739-6 CrossRefPubMed

18.

Chorianopoulos E, Krumsdorf U, Pleger ST, Katus HA, Bekeredjian R (2012) Incidence of late occurring bradyarrhythmias after TAVI with the self-expanding CoreValve((R)) aortic bioprosthesis. Clin Res Cardiol 101(5):349–355. doi:10.1007/s00392-011-0398-9 CrossRefPubMed

19.

Akin I, Kische S, Schneider H, Liebold A, Ortak J, Bansch D, Rehders TC, Thiele O, Schneider R, Kundt G, Krenz H, Chatterjee T, Nienaber CA, Ince H (2012) Surface and intracardiac ECG for discriminating conduction disorders after CoreValve implantation. Clin Res Cardiol 101(5):357–364. doi:10.1007/s00392-011-0400-6 PubMedCentralCrossRefPubMed

20.

Hoffmann R, Herpertz R, Lotfipour S, Aktug O, Brehmer K, Lehmacher W, Autschbach R, Marx N, Lotfi S (2012) Impact of a new conduction defect after transcatheter aortic valve implantation on left ventricular function. JACC Cardiovasc Interv 5(12):1257–1263. doi:10.1016/j.jcin.2012.08.011 CrossRefPubMed

21.

Buellesfeld L, Stortecky S, Heg D, Hausen S, Mueller R, Wenaweser P, Pilgrim T, Gloekler S, Khattab AA, Huber C, Carrel T, Eberle B, Meier B, Boekstegers P, Juni P, Gerckens U, Grube E, Windecker S (2012) Impact of permanent pacemaker implantation on clinical outcome among patients undergoing transcatheter aortic valve implantation. J Am Coll Cardiol 60(6):493–501. doi:10.1016/j.jacc.2012.03.054 CrossRefPubMed

22.

Lampe B, Hammerstingl C, Schwab JO, Mellert F, Stoffel-Wagner B, Grigull A, Fimmers R, Maisch B, Nickenig G, Lewalter T, Yang A (2012) Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block. Clin Res Cardiol 101(10):829–836. doi:10.1007/s00392-012-0468-7 CrossRefPubMed

23.

Eberhardt F, Hanke T, Fitschen J, Heringlake M, Bode F, Schunkert H, Wiegand UK (2012) AV interval optimization using pressure volume loops in dual chamber pacemaker patients with maintained systolic left ventricular function. Clin Res Cardiol 101(8):647–653. doi:10.1007/s00392-012-0439-z CrossRefPubMed

24.

Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, Sauren B, Mohr FW, Walther T, Zickmann B, Iversen S, Felderhoff T, Cartier R, Bonan R (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50(1):69–76 S0735-1097(07)01560-4 CrossRefPubMed

25.

WMA (2008) The Declaration of Helsinki. The World Medical Association. http://www.wma.net/e/policy/b3.htm. Accessed 23 Jan 2009

26.

Surawicz B, Childers R, Deal BJ, Gettes LS (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):976–981. doi:10.1016/j.jacc.2008.12.013 CrossRefPubMed

27.

Douglas PS, Garcia MJ, DE Haines, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Parker Ward R, Weiner RB (2011) ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr 24(3):229–267. doi:10.1016/j.echo.2010.12.008 CrossRefPubMed

28.

Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, Schiller NB, Stein JH, Weissman NJ (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17(10):1086–1119. doi:10.1016/j.echo.2004.07.013 PubMed

29.

Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJ, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW (2011) Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol 57(3):253–269. doi:10.1093/eurheartj/ehq406 CrossRefPubMed

30.

Nazif TM, Williams MR, Hahn RT, Kapadia S, Babaliaros V, Rodes-Cabau J, Szeto WY, Jilaihawi H, Fearon WF, Dvir D, Dewey TM, Makkar RR, Xu K, Dizon JM, Smith CR, Leon MB, Kodali SK (2013) Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J. doi:10.1093/eurheartj/eht376 PubMed

31.

Guetta V, Goldenberg G, Segev A, Dvir D, Kornowski R, Finckelstein A, Hay I, Goldenberg I, Glikson M (2011) Predictors and course of high-degree atrioventricular block after transcatheter aortic valve implantation using the CoreValve Revalving System. Am J Cardiol 108(11):1600–1605. doi:10.1016/j.amjcard.2011.07.020 CrossRefPubMed

32.

Jilaihawi H, Chin D, Vasa-Nicotera M, Jeilan M, Spyt T, Ng GA, Bence J, Logtens E, Kovac J (2009) Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J 157(5):860–866. doi:10.1016/j.ahj.2009.02.016 CrossRefPubMed

33.

Houthuizen P, Van Garsse LA, Poels TT, de Jaegere P, van der Boon RM, Swinkels BM, Ten Berg JM, van der Kley F, Schalij MJ, Baan J Jr, Cocchieri R, Brueren GR, van Straten AH, den Heijer P, Bentala M, van Ommen V, Kluin J, Stella PR, Prins MH, Maessen JG, Prinzen FW (2012) Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation 126(6):720–728 doi:10.1161/CIRCULATIONAHA.112.101055 CrossRefPubMed

34.

Jenkins C, Bricknell K, Chan J, Hanekom L, Marwick TH (2007) Comparison of two- and three-dimensional echocardiography with sequential magnetic resonance imaging for evaluating left ventricular volume and ejection fraction over time in patients with healed myocardial infarction. Am J Cardiol 99(3):300–306. doi:10.1016/j.amjcard.2006.08.026 CrossRefPubMed

35.

Schueler R, Sinning JM, Momcilovic D, Weber M, Ghanem A, Werner N, Nickenig G, Grube E, Hammerstingl C (2012) Three-dimensional speckle-tracking analysis of left ventricular function after transcatheter aortic valve implantation. J Am Soc Echocardiogr 25(8):827–834. doi:10.1016/j.echo.2012.04.023 CrossRefPubMed

36.

Sinning JM, Hammerstingl C, Vasa-Nicotera M, Adenauer V, Lema Cachiguango SJ, Scheer AC, Hausen S, Sedaghat A, Ghanem A, Muller C, Grube E, Nickenig G, Werner N (2012) Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation. J Am Coll Cardiol 59(13):1134–1141. doi:10.1016/j.jacc.2011.11.048 CrossRefPubMed

37.

Sinning JM, Ghanem A, Steinhauser H, Adenauer V, Hammerstingl C, Nickenig G, Werner N (2010) Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv 3(11):1141–1149. doi:10.1016/j.jcin.2010.09.009 CrossRefPubMed

38.

Seiffert M, Sinning JM, Meyer A, Wilde S, Conradi L, Vasa-Nicotera M, Ghanem A, Kempfert J, Hammerstingl C, Ojeda FM, Kim WK, Koschyk DH, Schirmer J, Baldus S, Grube E, Mollmann H, Reichenspurner H, Nickenig G, Blankenberg S, Diemert P, Treede H, Walther T, Werner N, Schnabel RB (2014) Development of a risk score for outcome after transcatheter aortic valve implantation. Clin Res Cardiol 103(8):631–640. doi:10.1007/s00392-014-0692-4 CrossRefPubMed

39.

Sherif MA, Zahn R, Gerckens U, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Richardt G, Schneider S, Senges J, Brachmann J (2014) Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry. Clin Res Cardiol 103(8):613–620. doi:10.1007/s00392-014-0690-6 CrossRefPubMed

40.

Egenrieder S, Hill S, Backes M, Vohringer M, Sechtem U (2014) Contained aortic annulus rupture with persisting false aneurysm after transfemoral transcatheter aortic valve implantation. Clin Res Cardiol 103(8):599–601. doi:10.1007/s00392-014-0696-0 CrossRefPubMed

41.

Diemert P, Lange P, Greif M, Seiffert M, Conradi L, Massberg S, Blankenberg S, Reichenspurner H, Hagl C, Schmitz C, Schrofel H, Treede H, Schymik G, Kupatt C (2014) Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol 103(3):183–190. doi:10.1007/s00392-013-0632-8 CrossRefPubMed

42.

Chorianopoulos E, Krumsdorf U, Geis N, Pleger ST, Giannitsis E, Katus HA, Bekeredjian R (2014) Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis. Clin Res Cardiol 103(1):65–72. doi:10.1007/s00392-013-0624-8 CrossRefPubMed

43.

Zuern CS, Eick C, Rizas KD, Stoleriu C, Barthel P, Scherer C, Muller KA, Gawaz M, Bauer A (2012) Severe autonomic failure in moderate to severe aortic stenosis: prevalence and association with hemodynamics and biomarkers. Clin Res Cardiol 101(7):565–572. doi:10.1007/s00392-012-0427-3 CrossRefPubMed

44.

Thilo C, Maurer CJ, Berlis A, von Scheidt W, Kasel AM (2014) Successful management of cerebral embolism during TAVR. Clin Res Cardiol 103(4):329–331. doi:10.1007/s00392-013-0652-4 CrossRefPubMed

Title: Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR
Authors: Marcel Weber
Eva Brüggemann
Robert Schueler
Diana Momcilovic
Jan-Malte Sinning
Alexander Ghanem
Nikos Werner
Eberhard Grube
Wolfgang Schiller
Fritz Mellert
Armin Welz
Georg Nickenig
Christoph Hammerstingl
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 11/2015
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-015-0865-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR

Abstract

Background

Methods and results

Conclusion

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

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2015

Authors’ reply concerning the letter by Ensminger et al.

Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014

Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy

Diastolic pressure–volume quotient (DPVQ) as a novel echocardiographic index for estimation of LV stiffness in HFpEF

Association between muscular strength and inflammatory markers among elderly persons with cardiac disease: results from the KORA-Age study

The relationship of QRS morphology with cardiac structure and function in patients with heart failure

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