Caroline S Gensas1, Adriano Caixeta2, Dimytri Siqueira3, Luiz A Carvalho4, Rogério Sarmento-Leite5, José A Mangione6, Pedro A Lemos7, Alexandre S Colafranceschi8, Paulo Caramori9, Maria Cristina Ferreira10, Alexandre Abizaid3, Fábio S Brito1. 1. Hospital Israelita Albert Einstein, São Paulo, Brazil. 2. Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: adriano.caixeta@einstein.br. 3. Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. 4. Hospital Pró-Cardíaco, Rio de Janeiro, Brazil. 5. Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil. 6. Hospital Beneficiência Portuguesa, São Paulo, Brazil. 7. Instituto do Coração da FMUSP, São Paulo, Brazil. 8. Instituto de Cardiologia Laranjeiras, Rio de Janeiro, Brazil. 9. Hospital São Lucas da PUC, Porto Alegre, Brazil. 10. Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil.
Abstract
BACKGROUND: The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. METHODS: Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. RESULTS: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p<0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p<0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation. CONCLUSION: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.
BACKGROUND: The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. METHODS: Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. RESULTS: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p<0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p<0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation. CONCLUSION: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.
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