Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations |
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Authors: | Oliver Husser Costanza Pellegrini Won-Keun Kim Andreas Holzamer Thomas Pilgrim Stefan Toggweiler Ulrich Schäfer Johannes Blumenstein Florian Deuschl Tobias Rheude Michael Joner Michael Hilker Christian Hengstenberg Helge Möllmann |
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Affiliation: | 1. Klinik für Innere Medizin I, Kardiologie, St. Johannes-Hospital Dortmund, Dortmund, Germany;2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany;3. Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany;4. Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany;5. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland;6. Department of Cardiology, Kantonsspital, Luzern, Switzerland;7. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany;8. German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany;9. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria |
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Abstract: | ObjectivesThis study sought to evaluate the impact of the ACURATE neo (NEO) (Boston Scientific, Marlborough, Massachusetts) versus SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) on permanent pacemaker implantation (PPI) in patients with pre-existing right bundle branch block (RBBB) after transcatheter aortic valve replacement.BackgroundPre-existing RBBB is the strongest patient-related predictor for PPI after transcatheter aortic valve replacement. No comparison of newer-generation transcatheter heart valves with regard to PPI in these patients exists.MethodsThis multicenter registry includes 4,305 patients; 296 (6.9%) had pre-existent RBBB and no pacemaker at baseline and formed the study population. The primary endpoint was new PPI at 30 days. The association of NEO versus S3 with PPI was assessed using binary logistic regression analyses and inverse probability treatment weighting in a propensity-matched population.ResultsThe 30-day PPI rate was 39.2%. The S3 and NEO were used in 66.9% and 33.1%, respectively. The NEO was associated with lower rates of PPI compared with the S3 (29.6% vs. 43.9%; p = 0.025; odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.32 to 0.89; p = 0.018), after multivariable adjustment (OR: 0.48; 95% CI: 0.26 to 0.86; p = 0.014), and in the inverse probability treatment weighting analysis (OR: 0.37; 95% CI: 0.25 to 0.55; p < 0.001). There was no difference in device failure (8.2% vs. 6.6%; p = 0.792) or in-hospital course. In the propensity-matched population, PPI rate was also lower in the NEO versus S3 (23.1% vs. 44.6%; p = 0.016; OR: 0.37; 95% CI: 0.17 to 0.78; p = 0.010), with no difference in device failure (9.2% vs. 6.2%; p = 0.742).ConclusionsIn patients with RBBB, risk of PPI was significantly lower with the NEO compared with the S3, suggesting the possibility of a patient tailored transcatheter heart valve therapy. |
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Keywords: | ACURATE neo permanent pacemaker implantations right bundle branch block SAPIEN 3 transcatheter aortic valve replacement CI confidence interval IPTW inverse probability treatment weighting MSCT multislice computed tomography OR odds ratio PPI permanent pacemaker implantations RBBB right bundle branch block TAVR transcatheter aortic valve replacement THV transcatheter heart valve VARC-2 Valve Academic Research Consortium-2 |
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