Riassunto analitico
- Background and aim of the study: As Transcatheter Aortic Valve Implantation becomes an increasingly widespread practice, conduction disturbances following TAVI and resulting in Permanent Pacemaker Implantation remain a clinical concern. In this context, the aim of the study was to assess long-term outcomes of patients undergoing PPI after TAVI, and to analyse their pacing burden.
- Methods: 308 patients with severe symptomatic aortic valve stenosis undergoing TAVI (from January 2017 to February 2024) were retrospectively evaluated. 48 were excluded due to having a previously implanted pacemaker. The final cohort of 260 patients was divided in two groups: 63 patients received a permanent pacemaker after TAVI, 197 did not receive it. Among these groups, anthropometric, clinical, echocardiographic, procedural, survival and rehospitalization data were collected to conduct the first step of study: evaluating all cause mortality and rehospitalization of PPI-post-TAVI patients. The second step of the study was to descriptively analyze ventricular stimulation among patients that implanted a pacemaker after TAVI: 44 patients completed the follow-up at 1 month and 1 year.
- Results: There was no significant difference in both mortality and rehospitalization between the PPI-post-TAVI group and the no-PPI-post-TAVI one (p=0,504 and 0,788 respectively). Self-expandable valves were markedly more associated with conduction disturbances and permanent pacemaker implantation after TAVI (OR: 2.591; 95% CI: 1.420 - 4.717; p=0,002). Moreover, valve dimension was significantly associated with PPI (p<0,001). Lastly, patients that were implanted with a pacemaker had longer hospital stay (average days: 9,5 vs 7,6; p=0,001). Analyzing device interrogation data, it emerged that patients implanting a pacemaker after TAVI for NOP-LBBB reduce their median pacing by 77% in the first year, while those that implant for AVB or alternating bundle branch block reduce their median pacing by 8,5%.
- Conclusions: Permanent Pacemaker Implantation after TAVI did not result in increased mortality or rehospitalization, but it resulted in longer hospital stay. Ventricular pacing during the first year after the procedure reduces more in patients that had PPI for a NOP-LBBB compared to those that received it for AVB.
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