Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/30199
Introduction: Complete atrioventricular block (AVB) leading to permanent pacemaker (PPM) requirement is a common complication of both surgical and transcatheter aortic valve replacement (SAVR and TAVR) but more frequently in TAVR. The primary aim of this study was to compare SAVR and TAVR cohorts with regard to rates and independent risk factors for PPM placement, as well as assess rates of AVB recovery and independent risk factors for long term PPM dependency.
Methods: The study included patients without prior PPM and infective endocarditis that underwent SAVR and TAVR at the Yale New Haven Hospital from 2012 to 2016. PPM dependency was defined as any ventricular pacing without resolution of AVB.
Results: Of the initial 1102 patients, 199 were excluded, 122 of those for prior PPM. Of those 903 remaining, 499 underwent SAVR and 404 TAVR. Rates of PPM were 4.6% and 14.4% for SAVR and TAVR respectively (p < 0.001). Right bundle branch block (RBBB) was identified as an individual risk factor for PPM following TAVR (odds ratio (OR): 7.86, 95% confidence interval (CI): 4.16 – 14.97, p < 0.001) while no specific risk factor was independently associated with PPM following SAVR. Of the 62 patients that required PPM for AVB following either SAVR or TAVR, 37.1% recovered within a mean of 31.2±44.5 days. Pre-operative Ca+2 channel blocker (CCB) therapy (OR: 14.91, 95% CI: 2.25 – 300.75, p = 0.018) and peripheral vascular disease (PVD) (OR: 5.91, 95% CI: 1.61 – 25.81, p = 0.011) were identified as independent risk factors for long-term PPM dependency.
Conclusions: The rate of PPM implantation was higher after TAVR compared to SAVR. RBBB was an independent risk factor for PPM placement following TAVR. A large portion of patients with AVB indication for PPM placement became independent of their PPM a short time after implantation. Pre-operative CCB therapy and PVD were independent risk factors for long-term PPM dependency.
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