Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:145-53 - Vol. 72 Num.02 DOI: 10.1016/j.rec.2018.01.011

Predictors of Need for Permanent Pacemaker Implantation and Conduction Abnormalities With a Novel Self-expanding Transcatheter Heart Valve

Costanza Pellegrini a, Oliver Husser a, Won-Keun Kim b,c, Andreas Holzamer d, Thomas Walther c, Tobias Rheude a, Nicola Patrick Mayr e, Teresa Trenkwalder a, Michael Joner a,f, Jonathan Michel a, Fabian Chaustre a, Adnan Kastrati a,f, Heribert Schunkert a,f, Christof Burgdorf g, Michael Hilker d, Helge Möllmann b, Christian Hengstenberg a,f,h,

a Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
b Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
c Department of Cardiovascular Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
d Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
e Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
f Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
g Herz- und Gefäßzentrum Bad Bevensen, Klinik für Kardiologie, Bad Bevensen, Germany
h Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

Keywords

Transcatheter aortic valve implantation. Conduction abnormalities. Permanent pacemaker implantation. Predictors.

Abstract

Introduction and objectives

The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR).

Methods

Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232).

Results

A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 ± 1.9 vs 7.1 ± 1.5 mm; P = .6 and 41.0 ± 7.9 vs 42.2 ± 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013).

Conclusions

New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors.

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1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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