Work

105 Impact of type of device and pacing parameters on re-hospitalisation and mortality following transcatheter aortic valve implantation – a 7 years retrospective analysis

Year: 2023

Type: conference-paper

Abstract: Introduction Transcatheter aortic valve implantation (TAVI) is a Class I indication1 in patients (pts) ≥75 years of age or who are at a high risk/unsuitable for surgery. Permanent pacemaker implantation (PPM) is a recognised complication of TAVI, being needed in up to 25% of pts2. RV pacing percentage>20%3 (RVP20) and paced QRS duration > 150 msec4 (PQRS 150) are potential predictors of pacing-induced cardiomyopathy Little known about the outcome of device therapy and pacing parameters on re-hospitalisation and mortality post-TAVI. Purpose To assess the impact of the type of device therapy and pacing parameters {RVP20, PQRS 150} on re-hospitalisation and mortality post-TAVI. Methods Retrospective analysis of consecutive pts requiring PPM following TAVI in a single tertiary centre between Jan 2016 and Feb 2022 (7 years) (Table 1). Electronic clinical and device records were analysed. Pts without re-hospitalisation and/or mortality data were excluded. Data were analysed for Whole Cohort (WhC), Brady Devices Group (BD), and Cardiac Resynchronisation Therapy Group (CRT). The Charlson comorbidity index 5 (CCI) was utilised to compare groups. Results (Table 2) PPM is required in 189 (19.23%) pts following TAVI. Follow-up data were available in 131 (69%) pts [117 (89%) BD, 14 (11%) CRT (Fig 1). The mean age of WhC is 82±6.66 years. Male to female ratio: 1.72. The CCI: was 4.58±1.23. Baseline LV function was normal in 70% of pts. Most (55%) paced for complete heart block. Dual chamber PPM, single chamber PPM, and CRT were implanted in 63%, 24%, and 11% respectively (Graph 1). Most PPMs were implanted as in-pts (79% vs 21%, P<0.0001), with pts needing CRT waiting longer than BD (10 days vs 5 days; p=0.0011). Two-thirds of CRT implants were performed as out-pts. In the BD, RVP20 and a PQRS150 were seen in 56% and 33% respectively. New onset LV dysfunction was noted in 8.4%. Deterioration in LV function seen in (a) 40% with RVP20 (OR:0.2526; 95% CI: 0.0583-1.0947; P=0.0659) and (b) in 30% of PQRS150 (OR:1.1887; 95% CI: 0.0521-27.1141; P=0.9137). 56% pts (56% BD versus 64.2% CRT p=NS) were re-hospitalised after device therapy (duration: 10±13 days, 4.5 days) of which 11% were due to decompensated heart failure and 4% to device-related issues. Most were due to non-cardiac causes. Over 7 years 43% pts died (Graph 2). Mean survival post-TAVI was 2.12 ± 1.49 years with no significant difference between the two groups (36% BD versus 42.83% CRT, P=NS). Cause of death was available in 29/56 (51.8%) with 16% dying due to cardiac causes. Conclusion In our experience, 1 in 5 patients post-TAVI required a PPM. The vast majority required a single or dual-chamber PPM with a smaller percentage requiring a CRT device. Most re-hospitalisations and deaths were due to non-cardiac causes. Kaplan Meir curves showed a trend towards better survival with CRT which was not statistically significant. RVP20 and PQRS150 resulted in heart failure-related hospitalisation in 1 in 3 patients. Conflict of Interest None

Source: Heart

DOI: 10.1136/heartjnl-2023-bcs.105