1. Permanent pacemaker implantation after transcatheter aortic valve implantation: impact on late clinical outcomes and left ventricular function
- Author
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Josep Rodés-Cabau, Sebastiano Immè, Henrique Barbosa Ribeiro, François Philippon, Corrado Tamburino, Robert DeLarochellière, Marco Barbanti, Antonio Dager, Javier E. López, Bruno García del Blanco, Asim N. Cheema, Angela Maria Cucalon, Antonio J. Muñoz-García, Ignacio J. Amat-Santos, Marina Urena, John G. Webb, Vicenç Serra, Juan H. Alonso Briales, Eric Dumont, Hatim Al Lawati, Luis Nombela-Franco, Luis M. Benitez, [Urena,M, Dumont,E, DeLarochellière,R, Ribeiro,HB, Nombela-Franco,L, Philippon,F, Rodés-Cabau,J] Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada. [Webb,JG, Barbanti,M] Hospital, University of British Columbia, Vancouver, BC, Canada. [Tamburino,C, Barbanti,M] Immè S. Ferrarotto Hospital, University of Catania, Italy [Muñoz-García,AJ, Alonso Briales,JH] Hospital Clínico de Málaga, Universidad de Málaga, Spain. [Cheema,A, Al Lawati,H] Michael’s Hospital, Toronto University, Canada. [Dager,AE, Benítez,LM, Cucalón,AM] Clínica de Occidente de Cali, Colombia. [Serra,V, García del Blanco,BG] Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Spain. [Amat-Santos,IJ, and López,J] Hospital Clínico Universitario de Valladolid, Spain.
- Subjects
Male ,Cardiac Catheterization ,Pacemaker, Artificial ,Time Factors ,Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings] ,Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over [Medical Subject Headings] ,Ventricular Function, Left ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Cohort Studies ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Retrospective Studies [Medical Subject Headings] ,Marcapaso artificial ,Función ventricular izquierda ,Prospective Studies ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Electrical Equipment and Supplies::Electrodes::Pacemaker, Artificial [Medical Subject Headings] ,Heart valves ,Anatomy::Cardiovascular System::Heart::Heart Valves::Aortic Valve [Medical Subject Headings] ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Ventricular function ,Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Cardiovascular Physiological Processes::Ventricular Function::Ventricular Function, Left [Medical Subject Headings] ,Cateterismo cardíaco ,Treatment Outcome ,Aortic Valve ,Cardiology ,Válvulas cardíacas ,Female ,Cardiology and Cardiovascular Medicine ,Implantación de prótesis de válvulas cardíacas ,medicine.medical_specialty ,Transcatheter aortic ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] ,Estudios de cohortes ,Anciano ,Check Tags::Male [Medical Subject Headings] ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Aged ,Retrospective Studies ,business.industry ,Aortic stenosis ,Surgery ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation [Medical Subject Headings] ,Pacemaker, artificial ,Check Tags::Female [Medical Subject Headings] ,Factores de tiempo ,Permanent pacemaker ,Resultado del tratamiento ,business ,Death, sudden, cardiac ,Follow-Up Studies - Abstract
Background— Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. Methods and Results— A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74–1.30; P =0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56–1.17; P =0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77–1.30; P =0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11–0.85; P =0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time ( P =0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6- to 12-month follow-up (estimated coefficient, −2.26; 95% confidence interval, −4.07 to −0.44; P =0.013; R 2 =0.121). Conclusions— The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
- Published
- 2013