Background

Conduction disturbances after transcatheter aortic valve implantation (TAVI) are common, heterogeneous, and frequently result in permanent pacemaker implantation (PPI). Pacemaker therapy with a high rate of right ventricular pacing is associated with heart failure, hospitalizations, and reduced quality of life.

Objective

The purpose of this study was to compare medium-term outcomes between PPI implantation strategies, as choosing the right indication for PPI is still an area of uncertainty and information on outcomes of PPI regimens beyond 1 year is rare.

Methods

We compared outcomes after 3 years between a restrictive PPI strategy, in which the lowest threshold for PPI was left bundle branch block (LBBB) (QRS >120 ms) with the presence of new atrioventricular block (PQ >200 ms), and a liberal PPI regimen, in which PPI already was performed in patients with new-onset LBBB.

Results

Between January 2014 and December 2016, TAVI was performed in 884 patients at our center. Of these, 383 consecutive, pacemaker-naive patients underwent TAVI with the liberal PPI strategy and subsequently 384 with the restrictive strategy. The restrictive strategy significantly reduced the percentage of patients undergoing PPI before discharge (17.2% vs 38.1%; P <.001). The incidence of the primary endpoint (all-cause-mortality and hospitalization for heart failure) after 3 years was similar in both groups (30.7% vs 35.2%; P = .242), as was all-cause-mortality (26.6% vs 29.2%; P = .718). Overall, patients who required PPI post-TAVI had significantly more hospitalizations due to heart failure (14.8% vs 7.8%; P = .004).

Conclusion

A restrictive PPI strategy after TAVI reduces PPI significantly and is safe in medium-term follow-up over 3 years.

中文翻译：

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经导管主动脉瓣植入术后三年结果：限制性与自由性起搏器植入策略的比较

背景

经导管主动脉瓣植入 (TAVI) 后的传导障碍是常见的、异质的，并且经常导致永久性起搏器植入 (PPI)。右心室起搏率高的起搏器治疗与心力衰竭、住院和生活质量下降有关。

客观的

本研究的目的是比较 PPI 植入策略之间的中期结果，因为选择正确的 PPI 适应症仍然是一个不确定的领域，而且关于 PPI 方案超过 1 年结果的信息很少。

方法

我们比较了限制性 PPI 策略 3 年后的结果，其中 PPI 的最低阈值是左束支传导阻滞 (LBBB) (QRS >120 ms)，存在新的房室传导阻滞 (PQ >200 ms) PPI 方案，其中 PPI 已在新发 LBBB 患者中进行。

结果

2014 年 1 月至 2016 年 12 月期间，我们中心对 884 名患者进行了 TAVI。其中，连续 383 名未使用起搏器的患者接受了自由 PPI 策略的 TAVI，随后 384 名患者接受了限制性策略。限制性策略显着降低了出院前接受 PPI 的患者百分比（17.2% 对 38.1%；P <.001）。3 年后，两组的主要终点（全因死亡率和因心力衰竭住院）的发生率相似（30.7% 对 35.2%；P = .242），全因死亡率（26.6% 对29.2%；P = .718）。总体而言，在 TAVI 后需要 PPI 的患者因心力衰竭住院的次数显着增加（14.8% 对 7.8%；P = .004）。

结论

TAVI 后限制性 PPI 策略可显着降低 PPI，并且在 3 年以上的中期随访中是安全的。