TY - JOUR
T1 - The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation
AU - Krishnaswamy, Amar
AU - Sammour, Yasser
AU - Mangieri, Antonio
AU - Kadri, Amer
AU - Karrthik, Antonette
AU - Banerjee, Kinjal
AU - Kaur, Manpreet
AU - Giannini, Francesco
AU - Pagliaro, Beniamino
AU - Ancona, Marco
AU - Pagnesi, Matteo
AU - Laricchia, Alessandra
AU - Weisz, Giora
AU - Lyden, Megan
AU - Bazarbashi, Najdat
AU - Gad, Mohamed
AU - Ahuja, Keerat
AU - Mick, Stephanie
AU - Svensson, Lars
AU - Puri, Rishi
AU - Reed, Grant
AU - Rickard, John
AU - Colombo, Antonio
AU - Kapadia, Samir
AU - Latib, Azeem
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/5/11
Y1 - 2020/5/11
N2 - Objectives: The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI). Background: Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI. Methods: Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI. Results: A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%). Conclusions: Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.
AB - Objectives: The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI). Background: Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI. Methods: Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI. Results: A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%). Conclusions: Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.
KW - atrial pacing
KW - electrophysiology study
KW - permanent pacemaker implantation
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jcin.2020.01.215
DO - 10.1016/j.jcin.2020.01.215
M3 - Article
C2 - 32305392
AN - SCOPUS:85083739386
SN - 1936-8798
VL - 13
SP - 1046
EP - 1054
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -