ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2021 April;62(2):169-74

DOI: 10.23736/S0021-9509.20.11342-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Electrocardiographic and clinical predictors for permanent pacemaker requirement after transcatheter aortic valve implantation: a 10-year single center experience

Daniele ERRIGO ¹ ✉, Pier G. GOLZIO ¹, Fabrizio D’ASCENZO ¹, Enrico RAGAGLIA ¹, Francesco BRUNO ¹, Stefano SALIZZONI ¹, Mattia PEYRACCHIA ¹, Davide CASTAGNO ¹, Carlo BUDANO ¹, Maurizio D’AMICO ¹, Simone FREA ¹, Enrico BALDI ², Carla GIUSTETTO ¹, Gaetano M. DE FERRARI ¹

¹ Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; ² Cardiac Intensive Care Unit, Division of Arrhythmia and Electrophysiology and Experimental Cardiology, Department of Medicine Science and Infective Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

BACKGROUND: The aim of this study is to identify clinical, electrocardiographic (ECG) and procedural predictors for permanent pacemaker (PPM) requirement after transaortic valve implantation (TAVI).
METHODS: All consecutive patients with severe symptomatic aortic stenosis (SSAS) undergoing TAVI at our single center were included in the study and prospectively followed. All patients had standard 12-leads ECGs recordings before and after TAVI and continuous ECG monitoring during hospital stay. Primary endpoint was to identify electrocardiographic predictors of PPM implantation after TAVI; secondary endpoint was to ascertain other clinical or procedure-related predictive factors of PPM need. PPM implantation was further arbitrarily divided into early and late one (beyond the 3^rd day).
RESULTS: Among the 431 patients undergoing TAVI between 2008 and 2018, 77 (18%) needed PPM implantation; 47 (11%) had an early procedure, and 30 (7%) a late implant. Preoperative right bundle branch block (RBBB) implies more than five-fold increase of the risk of PPM implantation (OR 5.19, CI 1.99-13.56, P=0.001), whereas the use of a self-expandable prosthesis is associated with an almost three-fold increase of the risk (OR 2.60, CI 1.28-5.28, P=0.008). In the late PPM implantation subgroup, only the history of syncope retains a significant association with such an increased risk (OR 2.71, CI 1.09-6.75, P=0.032).
CONCLUSIONS: The need of a PPM in the individual TAVI patient is hardly predictable. However, the finding of pre-existing RBBB, the use of self-expandable prosthesis and history of syncope can individuate patients at increased risk.

KEY WORDS: Aortic valve stenosis; Pacemaker, artificial; Heart block; Bundle-branch block