Siontis, Konstantinos C; Kara Balla, Abdalla; Cha, Yong-Mei; Pilgrim, Thomas; Sweda, Romy; Roten, Laurent; Reichlin, Tobias; Friedman, Paul A; Windecker, Stephan; Siontis, George C M (2023). Invasive electrophysiological testing to predict and guide permanent pacemaker implantation after transcatheter aortic valve implantation: A meta-analysis. Heart rhythm O2, 4(1), pp. 24-33. Elsevier 10.1016/j.hroo.2022.10.007
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BACKGROUND
Atrioventricular conduction abnormalities after transcatheter aortic valve implantation (TAVI) are common. The value of electrophysiological study (EPS) for risk stratification of high-grade atrioventricular block (HG-AVB) and guidance of permanent pacemaker (PPM) implantation is poorly defined.
OBJECTIVE
The purpose of this study was to identify EPS parameters associated with HG-AVB and determine the value of EPS-guided PPM implantation after TAVI.
METHODS
We performed a systematic review and meta-analysis of studies investigating the value of EPS parameters for risk stratification of TAVI-related HG-AVB and for guidance of PPM implantation among patients with equivocal PPM indications after TAVI.
RESULTS
Eighteen studies (1230 patients) were eligible. In 7 studies, EPS was performed only after TAVI, whereas in 11 studies EPS was performed both before and after TAVI. Overall PPM implantation rate for HG-AVB was 16%. AV conduction intervals prolonged after TAVI, with the AH and HV intervals showing the largest magnitude of changes. Pre-TAVI HV >70 ms and the absolute value of the post-TAVI HV interval were associated with subsequent HG-AVB and PPM implantation with odds ratios of 2.53 (95% confidence interval [CI] 1.11-5.81; P = .04) and 1.10 (95% CI 1.03-1.17; P = .02; per 1-ms increase), respectively. In 10 studies, PPM was also implanted due to abnormal EPS findings in patients with equivocal PPM indications post-TAVI (typically new left bundle branch block or transient HG-AVB). Among them, the rate of long-term PPM dependency was 57%.
CONCLUSION
Selective EPS testing may assist in the risk stratification of post-TAVI HG-AVB and in the guidance of PPM implantation, especially in patients with equivocal PPM indications post-TAVI.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Pilgrim, Thomas, Sweda, Romy, Roten, Laurent, Reichlin, Tobias Roman, Windecker, Stephan, Siontis, Georgios |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2666-5018 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
31 Jan 2023 13:11 |
Last Modified: |
01 Feb 2023 12:32 |
Publisher DOI: |
10.1016/j.hroo.2022.10.007 |
PubMed ID: |
36713040 |
Uncontrolled Keywords: |
Aortic stenosis Electrophysiological study Permanent pacemaker Risk stratification Transcatheter aortic valve implantation |
BORIS DOI: |
10.48350/178133 |
URI: |
https://boris.unibe.ch/id/eprint/178133 |
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