Prädikatoren der Schrittmacherpflicht nach perkutanem kathetergestützten Aortenklappenersatz (TAVI)

Predictors for permanent pacemaker implantation after TAVI

by Volkmar Grosse
Doctoral thesis
Date of Examination:2018-11-14
Date of issue:2018-11-14
Advisor:Prof. Dr. Bernd-Dieter Gonska
Referee:Prof. Dr. Bernd-Dieter Gonska
Referee:Prof. Dr. Theodor Tirilomis
Persistent Address: http://dx.doi.org/10.53846/goediss-7139

 

 

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Abstract

English

Background: Transcatheter aortic valve implantation (TAVI) has become an adequate treatment option for patients with an increased surgical risk. With further improvements the procedure expands towards younger and lower risk patients. However, the most common complication of the procedure is the occurrence of conduction disturbances leading to the need for permanent pacemaker implantation (PMI). There have been studies trying to identify predictors for conduction disturbances and PMI, which were usually obtained in highly selected patient groups, partially with contradictory results and thus requiring further confirmation. Aim of this study was to find out predictors for PMI after TAVI and possible recommendation for preventive PMI after TAVI. Methods: In this retrospective data analysis we evaluated an all-comers patients collective who underwent TAVI for treatment of severe aortic stenosis at the TAVI center in Karlsruhe (TAVIK) in 2012 and 2013. We analyzed patient baseline characteristics and 12-lead-ECG before and after the procedure. Results: 676 consecutive patients were evaluated. Patients with a permanent pacemaker prior to the TAVI procedure were excluded. 84 patients needed PMI (15,5%). There was a significant difference between the two groups concerning the premedication with digitalis with a higher rate in the group of patients with PMI after TAVI (13,1% vs. 5%, p=0,005) , which was also confirmed in the multivariate logistic regression analysis (OR 2.64, 95% CI 1.13-6.19; p=0.025). Furthermore, our data showed the pre-existing right bundle branch block as a significant predictor for PMI (26,2% vs. 6,8%, p=0,001), (OR 5.19, 95% CI 2.68 - 10.05; p<0.01). The use of self-expanding valves (57,1% vs. 27,1%, p=0,001), (p <0.01, OR 3,56, 95% CI 2.12-5.94) and the transfemoral approach (81% vs. 67,9%, p=0,019), (p = 0.034, OR 1.97, 95% CI 1.05-3.67) were independent predictors of the development of a conduction disturbance with the need for PMI after TAVI. Conclusion: It can only be assumed that there is an increased probability of developing post-procedural need for pacing following TAVI if the patient has a certain risk profile and is supplied with a specific type of valve. Based on current data and also the results of this analysis no recommendations for preventive PMI can be given.
Keywords: TAVI
 
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