TY  - BOOK
AU  - Pichard, Augusto D
TI  - Chronic pacing and adverse outcomes after transcatheter aortic valve implantation
SN  - 1468-201X
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Bundle-Branch Block/th [Therapy]
KW  - *Pacemaker, Artificial/ae [Adverse Effects]
KW  - *Transcatheter Aortic Valve Replacement
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/co [Complications]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Bundle-Branch Block/co [Complications]
KW  - Bundle-Branch Block/mo [Mortality]
KW  - Electrocardiography
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Male
KW  - Prognosis
KW  - Survival Rate/td [Trends]
KW  - Treatment Outcome
KW  - United States/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Multicenter Study
KW  - Randomized Controlled Trial
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006
N2  - 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
UR  - http://dx.doi.org/10.1136/heartjnl-2015-307666
ER  -