MedStar Authors catalog › Details for: Utility of Invasive Electrophysiology Studies in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation.
Utility of Invasive Electrophysiology Studies in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. Journal: The American journal of cardiology.Published: 2018ISSN: 0002-9149.UI/PMID: 29598854.Subject(s): Aged | Aged, 80 and over | *Aortic Valve Stenosis/su [Surgery] | *Bundle-Branch Block/di [Diagnosis] | Bundle-Branch Block/pp [Physiopathology] | Bundle-Branch Block/th [Therapy] | Cardiac Pacing, Artificial | *Electrophysiologic Techniques, Cardiac/mt [Methods] | Female | *Heart Valve Prosthesis | Humans | Length of Stay | Male | Middle Aged | Mortality | Pacemaker, Artificial | *Postoperative Complications/di [Diagnosis] | Postoperative Complications/pp [Physiopathology] | Postoperative Complications/th [Therapy] | Severity of Illness Index | *Transcatheter Aortic Valve ReplacementInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1016/j.amjcard.2018.02.015 (Click here) Abbreviated citation: Am J Cardiol. 121(11):1351-1357, 2018 06 01.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Permanent pacemaker (PPM) implantation remains common after transcatheter aortic valve implantation (TAVI). Invasive electrophysiology studies (EPSs) may reduce PPM implantation rates by identifying patients who do not require long-term pacing. At our institution, a new strategy in which patients with equivocal indications for pacing underwent EPSs to determine the need for PPM implantation was adopted. We compared baseline demographics, TAVI procedural details, and outcomes in patients without any conduction disturbance after TAVI, patients with new PPM implantation, and patients with EPS+/-new PPM implantation. After exclusion for preexisting PPMs, of a total of 614 consecutive TAVI patients, 117 (19.1%) required new PPM implantation for unequivocal pacing indications, and 95 (15.5%) underwent EPSs. Of those patients who underwent EPSs, 28 (29.5%) required PPM implantation and 67 (70.5%) did not. The overall rate of new PPM implantation was higher for self-expanding versus balloon-expandable valves (34.0% vs 19.9%, p=0.0011). PPM implantation increased intensive care and hospital length of stay compared with patients without any conduction disturbance (10.7+/-8.3 vs 8.5+/-6.4 days, p=0.003). A negative EPS did not prolong length of stay. There were no significant differences in 30-day and 1-year mortality between groups. In conclusion, among TAVI patients with new-onset conduction disturbance, EPS is a safe strategy to identify those who require PPM implantation and those in whom PPMs can be avoided.Abstract: Copyright (c) 2018 Elsevier Inc. All rights reserved.