Impact of pacemaker mode in patients with atrioventricular conduction disturbance after trans‐catheter aortic valve implantation. Issue 7 (14th March 2018)

• Record Type: Journal Article
• Authors: Takahashi, Masao; Badenco, Nicolas; Monteau, Jacques; Gandjbakhch, Estelle; Extramiana, Fabrice; Urena, Marina; Karam, Nicole; Marijon, Eloi; Algalarrondo, Vincent; Teiger, Emmanuel; Lellouche, Nicolas
• Is Part Of: Catheterization and cardiovascular interventions. Volume 92:Issue 7(2018)
• Page Start: 1380
• Page End: 1386
• Publication Date: 2018-03-14
• Subjects: atrioventricular conduction disturbance -- mode switch algorithm -- pacemaker mode -- transcatheter aortic valve implantation; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.27594
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: This study aimed to assess the impact of pacemaker mode programming on clinical outcomes in patients with high‐degree atrioventricular conduction disturbance (AVCD) after transcatheter aortic valve implantation (TAVI). Background: Although high‐degree AVCD after TAVI can receive pacemaker, recovery of the AVCD is often observed. Specific pacemaker algorithms (AAI‐DDD mode switch) are available which favor spontaneous atrioventricular conduction. Methods: Of 1, 621 consecutive multi‐center TAVI patients, 269 (16.4%) received pacemaker. We retrospectively included 91 patients with persistent high‐degree AVCD at hospital discharge. Pacemaker dependency was defined as absence, inadequate intrinsic ventricular rhythm, or ventricular pacing time > 95% on pacemaker interrogation during follow‐up. Comparison of heart failure hospitalization and death between conventional DDD (cDDD) and other modes was examined (AAI‐DDD and VVI). Results: During a mean follow‐up duration of 13 months, the pacemaker dependency rate was 52.8%. Patients with cDDD mode (N = 36: 40.0%) had significantly more pacemaker dependency. Multivariate analysis showed that cDDD mode was independently associated with pacemaker dependency (odds ratio = 3.63, P = 0.03). Moreover, cDDD patients had a significant higher incidence of heart failure hospitalization (Hospitalization: cDDD vs. others = 45.4% vs. 18.2%, P = 0.03) and had a higher incidence of mortality (Death: cDDD vs. the others = 27.0% vs. 4.4%, P = 0.06). Conclusions: Up to half of patients implanted for high‐degree AVCD after TAVI had conduction recovery. Patients with cDDD programming at hospital discharge had more pacemaker dependency and a worse cardiac prognosis. Thus, pacemaker mode should be systematically set to promote spontaneous atrioventricular conduction in patients with pacemaker implantation after TAVI.