TY - JOUR
T1 - Atrioventricular conduction in PM recipients after transcatheter aortic valve implantation: Implications using Wenckebach point measurement
AU - Pelargonio, Gemma
AU - Scacciavillani, Roberto
AU - Donisi, Luca
AU - Narducci, Maria Lucia
AU - Aurigemma, Cristina
AU - Pinnacchio, Gaetano
AU - Bencardino, Gianluigi
AU - Perna, Francesco
AU - Spera, Francesco Raffaele
AU - Comerci, Gianluca
AU - Ruscio, Eleonora
AU - Romagnoli, Enrico
AU - Crea, Filippo
AU - Burzotta, Francesco
AU - Trani, Carlo
PY - 2022
Y1 - 2022
N2 - BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up. ObjectivesThe aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing. MethodsWe enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination. ResultsA total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and patients with valid AV conduction (WP >= 100; 17). In the first group patients had a significantly higher number of intraprocedural atrioventricular block (AVB) (20 vs. 1, p < 0.005), showed a significant higher implantation depth in LVOT (7.7 +/- 2.2 vs. 4.4 +/- 1.1, p < 0.05) and lower Delta MSID (-0.28 +/- 3 vs. -3.94 +/- 2, p < 0.05). ConclusionAV conduction may recover in a significant proportion of patients. In our study, valve implantation depth in the LVOT and intraprocedural AV block are associated with severely impaired AV conduction. Regular PM interrogation and reprogramming are required to avoid unnecessary permanent right ventricular stimulation in patients with AV conduction recovery.
AB - BackgroundAtrioventricular (AV) conduction disturbances requiring permanent pacemaker implantation (PPI) are a common complication after transcatheter aortic valve implantation (TAVI). However, a significant proportion of patients might recover AV conduction at follow-up. ObjectivesThe aim of our study was to evaluate the recovery of AV conduction by determination through Wenckebach point in patients with PPI and therefore identify patients who could benefit from device reprogramming to avoid unnecessary RV pacing. MethodsWe enrolled 43 patients that underwent PM implantation after TAVI at our Department from January 2018 to January 2021. PM interrogation was performed at follow-up and patients with native spontaneous rhythm were further assessed for AV conduction through WP determination. ResultsA total of 43 patients requiring a PM represented the final study population, divided in patients with severely impaired AV conduction (no spontaneous valid rhythm or WP < 100; 26) and patients with valid AV conduction (WP >= 100; 17). In the first group patients had a significantly higher number of intraprocedural atrioventricular block (AVB) (20 vs. 1, p < 0.005), showed a significant higher implantation depth in LVOT (7.7 +/- 2.2 vs. 4.4 +/- 1.1, p < 0.05) and lower Delta MSID (-0.28 +/- 3 vs. -3.94 +/- 2, p < 0.05). ConclusionAV conduction may recover in a significant proportion of patients. In our study, valve implantation depth in the LVOT and intraprocedural AV block are associated with severely impaired AV conduction. Regular PM interrogation and reprogramming are required to avoid unnecessary permanent right ventricular stimulation in patients with AV conduction recovery.
KW - Wenckebach point
KW - atrioventricular conduction
KW - pacing
KW - personalized medicine
KW - transcatheter aortic valve implantation (TAVI)
KW - Wenckebach point
KW - atrioventricular conduction
KW - pacing
KW - personalized medicine
KW - transcatheter aortic valve implantation (TAVI)
UR - http://hdl.handle.net/10807/216175
U2 - 10.3389/fcvm.2022.904828
DO - 10.3389/fcvm.2022.904828
M3 - Article
SN - 2297-055X
VL - 9
SP - N/A-N/A
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
ER -