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The Journal of Cardiovascular Surgery 2020 Sep 04

DOI: 10.23736/S0021-9509.20.11342-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

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, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; 2 Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Department of Medicine Science and Infective Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy


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BACKGROUND: 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 centre 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 3rd 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. Pre-operative 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 selfexpandable 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: TAVI; Aortic stenosis; Pacemaker; Atrio-ventricular block; Right bundle branch block; Left bundle branch block

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