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Early and Late Pacemaker Implantation after Transcatheter Aortic Valve Implantation
Session:
SESSÃO DE POSTERS 24 - COMPLICAÇÕES NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker:
Tomás M. Carlos
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Tomás M. Carlos; Bernardo Resende; Diogo Fernandes; Joana Guimarães; Gonçalo Terleira Batista; Tatiana Santos; Luísa Gomes Rocha; Mafalda Griné; Luís Leite; Marco Costa; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Pacemaker implantation (PI) is a common complication of transcatheter aortic valve implantation (TAVI), due to the proximity of the implanted valve to the heart’s conduction system. The European Society of Cardiology recommends at least 7 days of surveillance for conduction disturbances, leading to prolonged hospitalizations. This study aimed to assess differences between early and late PI, based on our centre’s median time to PI, and to identify predictors of late PI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We conducted a retrospective, single-centre study of TAVI patients from March 2020 to September 2023. Patients were categorized in three groups: early-PI (≤ 2 days), late-PI (3-30 days), and no PI within 30 days of follow-up. Those with prior pacemaker were excluded. Baseline characteristics were compared, and binary logistic regression was performed to identify predictors of late PI, after excluding early PI cases.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Among 542 patients, 67 (12.4%) underwent early PI, while 51 (9.4%) required late PI. Patients in early PI group were older (83.1±5.4 years, <em>p</em>=0.021) and had a higher prevalence of right bundle branch block (RBBB) (37.9%, <em>p</em><0.001). Late PI patients showed trends toward higher rates of type 2 insulin-treated diabetes and chronic kidney disease under dialysis. Notably, while the presence of pre-existing left bundle branch block (LBBB) did not influence the likelihood of PI, post-TAVI <em>de novo </em>LBBB was strongly associated with late PI. Regarding valve types, the <em>Accurate Neo2</em>® prosthesis showed no significant association with PI, while the <em>Navitor</em>® valve was linked to late PI and the <em>Evolut</em>® valve with early PI. Comparing early and late PI cases, early PI was primarily associated with pre-existing RBBB and use of the <em>Evolut</em>®<em> </em>valve, whereas late PI group correlated with post-TAVI <em>de novo</em> LBBB and use of the <em>Navitor</em>® valve. After excluding early PI patients, binary logistic regression identified <em>de novo </em>LBBB (OR 1.926, CI 1.001 – 3.706, <em>p</em>=0.050), <em>Navitor</em>® valve use (OR 3.152, CI 1.495 – 6.644, <em>p</em>=0.003) and chronic kidney disease under dialytic treatment (OR 18.048, CI 1.530-212.878, <em>p</em>=0.022) as significant predictors of late PI. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Optimizing discharge timing after TAVI requires careful evaluation of conduction disturbances. Our findings suggest that patients with <em>de novo </em>LBBB and with <em>Navitor</em>® valve implanted, as well as dialysed patients, should warrant closer monitoring and potentially extended observation periods.</span></span></p>
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