Validation of the 2019 Expert Consensus Algorithm for the Management of Conduction Disturbances After TAVR |
| |
| Authors: | Daniel Malebranche Joanna Bartkowiak Christoph Ryffel Benedikt Bernhard Mamdouh Elsmaan Nikolas Nozica Taishi Okuno Jonas Lanz Fabien Praz Stefan Stortecky Lorenz Räber Dik Heg Laurent Roten Stephan Windecker Thomas Pilgrim Tobias Reichlin |
| |
| Affiliation: | 1. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland;2. Dalhousie University and Queen Elizabeth II Health Sciences Centre and NS Health Authority, Halifax, Nova Scotia, Canada;3. Clinical Trials Unit, University of Bern, Bern, Switzerland |
| |
| Abstract: | ObjectivesThe aim of this study was to validate the 2019 consensus algorithm in a large cohort of contemporary transcatheter aortic valve replacement (TAVR) patients.BackgroundThe optimal management of patients with atrioventricular conduction disturbances after TAVR is unknown. Guidance was consolidated in an expert consensus algorithm in 2019.MethodsIn a retrospective analysis of a prospective registry, patients were classified according to the 2019 consensus algorithm as eligible for early discharge (day 1 or 2 after TAVR), higher risk for high-degree atrioventricular block (HAVB) or complete heart block (CHB) or in need for a permanent pacemaker (PPM). The primary endpoint was the incidence of PPM implantation for HAVB or CHB within 30 days after TAVR. Patients with prior PPM or implantable cardioverter-defibrillator implantation, valve-in-valve procedures, or incomplete electrocardiographic data were excluded.ResultsAmong 1,439 patients undergoing TAVR between January 2014 and December 2019, the 2019 consensus algorithm classified 73% as eligible for early discharge, 21% as at higher risk for HAVB or CHB, and 6% as in need of PPM. PPM implantation for HAVB or CHB occurred in 234 patients (16%) within 30 days after TAVR. The incidence of PPM implantation was 2.7% in the early discharge group, 41% in the group with higher risk for HAVB or CHB, and 100% in the PPM group.ConclusionsThe 2019 consensus algorithm safely identifies patients with no need for PPM implantation. This strategy allows more uniform management of TAVR patients and facilitates early discharge of low-risk patients without prolonged monitoring in 3 of 4 patients. However, the algorithm is less precise in the identification of high-risk patients. |
| |
| Keywords: | conduction disturbances ECG algorithm pacemaker implantation transcatheter aortic valve replacement AV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" atrioventricular AVB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" atrioventricular block BEV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" balloon-expandable valve CHB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" complete heart block ECG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" electrocardiographic HAVB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" high-degree atrioventricular block LBBB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" left bundle branch block MEV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" mechanically expandable valve PPM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" permanent pacemaker RBBB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" right bundle branch block SEV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" self-expanding valve TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
