Chronic pacing and adverse outcomes after transcatheter aortic valve implantation.

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Citation: Heart. 101(20):1665-71, 2015 Oct.PMID: 26261157Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter Study | Randomized Controlled Trial | Research Support, Non-U.S. Gov'tSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Bundle-Branch Block/th [Therapy] | *Pacemaker, Artificial/ae [Adverse Effects] | *Transcatheter Aortic Valve Replacement | Aged, 80 and over | Aortic Valve Stenosis/co [Complications] | Aortic Valve Stenosis/mo [Mortality] | Bundle-Branch Block/co [Complications] | Bundle-Branch Block/mo [Mortality] | Electrocardiography | Female | Follow-Up Studies | Humans | Male | Prognosis | Survival Rate/td [Trends] | Treatment Outcome | United States/ep [Epidemiology]Local holdings: Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1468-201X
Name of journal: Heart (British Cardiac Society)Abstract: CONCLUSIONS: In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings.METHODS AND RESULTS: Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01). Prior PPM had worsened recovery of LVEF after TAVI (DELTA=10.0 prior vs 19.7% no PPM for baseline LVEF <35%, p<0.0001; DELTA=4.1 prior vs 7.4% no PPM for baseline LVEF 35-50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (>88%).OBJECTIVE: Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT00530894).Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.All authors: Babaliaros V, Biviano A, Dizon JM, Douglas PS, Fearon WF, Garan H, Hahn RT, Herrmann HC, Hess PL, Jilaihawi H, Kapadia S, Kodali SK, Leon MB, Makkar R, Nazif TM, PARTNER Publications Office, Pichard AD, Smith CR, Szeto WY, Tuzcu EM, Williams M, Xu KDigital Object Identifier: Date added to catalog: 2016-01-15
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 26261157

Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006

CONCLUSIONS: In the PARTNER trial, prior PPM, along with new PPM and chronic LBBB patients, had worsened clinical and echocardiographic outcomes relative to no PPM patients, and the presence of a PPM was independently associated with 1-year mortality. Ventricular dyssynchrony due to chronic RV pacing may be mechanistically responsible for these findings.

METHODS AND RESULTS: Four groups of patients undergoing TAVI in the Placement of Aortic Transcatheter Valves (PARTNER) trial and registries were compared: prior PPM (n=586), new PPM (n=173), no PPM (n=1612), and left bundle branch block (LBBB)/no PPM (n=160). At 1 year, prior PPM, new PPM and LBBB/no PPM had higher all-cause mortality than no PPM (27.4%, 26.3%, 27.7% and 20.0%, p<0.05), and prior PPM or new PPM had higher rehospitalisation or mortality/rehospitalisation (p<0.04). By Cox regression analysis, new PPM (HR 1.38, 1.00 to 1.89, p=0.05) and prior PPM (HR 1.31, 1.08 to 1.60, p=0.006) were independently associated with 1-year mortality. Surviving prior PPM, new PPM and LBBB/no PPM patients had lower LVEF at 1 year relative to no PPM (50.5%, 55.4%, 48.9% and 57.6%, p<0.01). Prior PPM had worsened recovery of LVEF after TAVI (DELTA=10.0 prior vs 19.7% no PPM for baseline LVEF <35%, p<0.0001; DELTA=4.1 prior vs 7.4% no PPM for baseline LVEF 35-50%, p=0.006). Paced ECGs displayed a high prevalence of RV pacing (>88%).

OBJECTIVE: Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.

TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov NCT00530894).Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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