Spectrum Health - Michigan State University, Grand Rapids, MI, United States of America; Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, United States of America.
Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
Cardiovasc Revasc Med. 2022 Sep;42:17-25. doi: 10.1016/j.carrev.2022.03.018. Epub 2022 Mar 26.
To evaluate the use of temporary-permanent pacemaker (TPP) in patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). We also sought to identify key predictors of permanent pacemaker (PPM) within 30 days of TAVR in this population.
RBBB is a well-recognized risk factor for PPM post TAVR. TPP provides stable transient pacing and reduces the need for critical care beds.
This is a retrospective chart review of 371 patients who underwent TAVR at our institution. All patients with pre-existing RBBB had TPP placed prior to TAVR (n = 37). The primary outcome was the need for critical care beds. Multivariate logistic regression analysis was performed to identify predictors of PPM within 30 days of TAVR.
67 patients required PPM within 30 days of TAVR, and 56 implanted before discharge. 51% (19 out of 37) of TPP group required PPM before discharge compared to 11% (37 out of 334) of No TPP (p < 0.001), yet TPP group spent significantly fewer hours in a critical care bed (19 vs 28 h, p = 0.01). Length of membranous septum (LMS) <8.49 mm was the strongest independent predictor of PPM within 30 days of TAVR (RAUC of 0.80, Sensitivity 0.7 and Specificity 0.8) and 98% of patients with LMS < 7 mm required PPM within 30 days.
TPP-TAVR is a well-defined multidisciplinary protocol that reduces the need for critical care beds in patients with pre-existing RBBB referred for TAVR. Additionally, LMS is the strongest predictor of PPM implantation in this population. CONDENSED ABSTRACT (100 WORDS): This study evaluated the use of temporary-permanent pacemakers (TPP) in patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). TPP-TAVR provided stable pacing allowing for early mobilization and reduced the need for critical care beds. Multivariate logistic regression analysis identified length of membranous septum (LMS) <8.49 mm in patients with RBBB as the strongest independent predictor of PPM need within 30 days of TAVR. 98% of patients with RBBB and LMS < 7 mm required PPM at 30 days regardless of other characteristics including valve type and size.
评估在接受经导管主动脉瓣置换术（TAVR）的右束支传导阻滞（RBBB）患者中使用临时-永久起搏器（TPP）的情况。我们还试图确定该人群中 TAVR 后 30 天内植入永久性起搏器（PPM）的关键预测因素。
RBBB 是 TAVR 后 PPM 的公认危险因素。TPP 提供稳定的临时起搏，减少对重症监护病床的需求。
这是对在我们机构接受 TAVR 的 371 例患者进行的回顾性图表审查。所有存在预先存在的 RBBB 的患者在 TAVR 前均放置了 TPP（n=37）。主要结局是需要重症监护病床。进行多变量逻辑回归分析以确定 TAVR 后 30 天内 PPM 的预测因素。
67 例患者在 TAVR 后 30 天内需要 PPM，其中 56 例在出院前植入。与无 TPP 组的 11%（37/334）相比，TPP 组中有 51%（19/37）在出院前需要 PPM（p<0.001），但 TPP 组在重症监护病床的时间显著减少（19 小时与 28 小时，p=0.01）。膜间隔长度（LMS）<8.49mm 是 TAVR 后 30 天内 PPM 的最强独立预测因素（0.80 的 AUC，敏感性为 0.7，特异性为 0.8），98%的 LMS<7mm 的患者在 30 天内需要 PPM。
TPP-TAVR 是一种明确的多学科方案，可减少 RBBB 患者 TAVR 前需要重症监护病床的需求。此外，LMS 是该人群中 PPM 植入的最强预测因素。
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