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Permanent pacemaker reduction using temporary-permanent pacemaker as a 1-month bridge after transcatheter aortic
Sanshuai Chang1, Zhengming Jiang1, Xinmin Liu1
1Interventional Center of Valvular Heart Disease, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China.
Eclinicalmedicine
|July 16, 2024
Summary
Temporary-permanent pacemaker (TPPM) use as a one-month bridge significantly reduced permanent pacemaker implantation rates after transcatheter aortic valve replacement (TAVR). This strategy helps identify reversible conduction disturbances, optimizing patient management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Transcatheter aortic valve replacement (TAVR) is associated with variable rates of permanent pacemaker (PPM) implantation due to conduction disturbances.
- Optimizing temporary pacing strategies after TAVR remains an area needing further investigation.
Purpose of the Study:
- To evaluate the efficacy of a temporary-permanent pacemaker (TPPM) as a one-month bridge strategy in reducing the rate of PPM implantation after TAVR.
- To assess the reversibility of conduction disturbances following TAVR.
Main Methods:
- A prospective, multicentre, single-arm observational study involving patients undergoing TAVR.
- Patients developing high-degree atrioventricular block or complete heart block post-TAVR received TPPM for one month.
- Primary endpoint was freedom from PPM implantation indications at one month post-TAVR.
Main Results:
- Of 70 patients receiving TPPM, 75.7% did not require PPM implantation at one month.
- The overall PPM implantation rate at one month was 2.47%, a significant reduction from the 48-hour rate (8.28%).
- Baseline PR interval, septal length/depth difference, and timing of conduction disturbance were predictors of PPM independence.
Conclusions:
- Utilizing TPPM as a one-month bridge effectively identifies reversible conduction disturbances, significantly lowering the need for PPM implantation post-TAVR.
- Further confirmation through randomized controlled trials is warranted to validate these findings.
Keywords:
High-degree atrioventricular blockPacemaker dependencyPermanent pacemakerTemporary-permanent pacemakerTranscatheter aortic valve replacement
