Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.
Institute of Cardiovascular Science, University College London, UK.
Pacing Clin Electrophysiol. 2022 Jan;45(1):103-110. doi: 10.1111/pace.14397. Epub 2021 Dec 26.
Permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve implantation (TAVI). The optimum timing of PPM implantation is still unclear as conduction abnormalities evolve and a balance needs to be struck between conservative delays in the hope of conduction recovery and overutilization of pacing. This study aimed to assess the safety and efficacy of early PPM implantation, without an observation period, among TAVI patients.
This is a retrospective, observational study of 1398 TAVI patients. Clinical and pacing data were collected at baseline, 30 days and at a median of 15 (4-21) months post-TAVI. Study endpoints included PPM-related complications, pacing utilization and hospital length of stay.
One hundred five patients (8.2%) required a PPM, of which 13 were implanted pre and 92 post-TAVI. Seventy-six percent required pacing for either second- or third-degree heart block. Time to implantation for post-TAVI PPM was 1 (0-3) day. Six patients experienced a pacing-related complication- lead displacement (n = 3), hematoma (n = 2), and device infection (n = 1). Pacing utilization defined as pacing >10% of the time or a pacing requirement at the time of the pacing check was demonstrated in 83% of patients. Multivariate analysis revealed complete heart block (CHB) was the only independent predictor of pacing utilization. Hospital length of stay for the post-TAVI PPM group was longer than the group without PPM (4 [2-8] vs. 3 [2-4] days; p < .001).
Early PPM implantation in TAVI patients is safe and majority of patients require pacing in the short and mid-term.
经导管主动脉瓣植入术（TAVI）后常发生永久性心脏起搏器（PPM）植入。传导异常不断发展，在期待传导恢复的保守延迟和起搏过度利用之间需要取得平衡，因此 PPM 植入的最佳时机仍不清楚。本研究旨在评估 TAVI 患者中早期（无观察期）植入 PPM 的安全性和有效性。
这是一项回顾性、观察性研究，共纳入 1398 例 TAVI 患者。在基线、TAVI 后 30 天和中位数 15（4-21）个月时采集临床和起搏数据。研究终点包括与 PPM 相关的并发症、起搏利用情况和住院时间。
105 例（8.2%）患者需要植入 PPM，其中 13 例为 TAVI 前植入，92 例为 TAVI 后植入。76%需要起搏治疗二度或三度房室传导阻滞。TAVI 后 PPM 的植入时间为 1（0-3）天。6 例患者发生与起搏相关的并发症，包括导线移位（n=3）、血肿（n=2）和设备感染（n=1）。起搏利用率定义为起搏时间超过 10%或在起搏检查时需要起搏，83%的患者存在起搏利用率。多变量分析显示完全性心脏阻滞（CHB）是起搏利用的唯一独立预测因素。TAVI 后 PPM 组的住院时间长于无 PPM 组（4[2-8]天比 3[2-4]天；p<0.001）。
TAVI 患者早期植入 PPM 安全，大多数患者在短期和中期需要起搏。
