valve implantation (TAVI) is the occurrence of atrioventricular (AV) conduction disorders secondary to AV node or His bundle injury leading to permanent pace-.
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Antibradycardia pacing ANTIBRADYCARDIA PACING
P1664 | BEDSIDE Risk factors predicting complications of transvenous lead extraction
P1663 | BEDSIDE Patients with new-onset persistent left bundle branch block associated with prolonged PR or HV interval in post TAVI benefit from permanent pacemaker implantation A. Mirolo, E. Durand, G. Viart, A. Savoure, B. Godin-Gardea, N. Auquier, H. Eltchaninoff, F. Anselme. University Hospital of Rouen, Cardiology, Rouen, France Introduction: One of the most frequent complications of transcatheter aortic valve implantation (TAVI) is the occurrence of atrioventricular (AV) conduction disorders secondary to AV node or His bundle injury leading to permanent pacemaker implantation (PPI). Aim: The objective was to quantify the rate of ventricular pacing (VP) according to post-TAVI PPI indication using recorded pacemaker memories. Methods: From October 2009 to January 2017, all patients who underwent PPI following TAVI in a university hospital were included. Primary endpoint was VP rate at the first device control (a VP rate ≥1% was considered as significant). Single chamber pacemakers were programmed at a minimal pacing rate of 50 beats per minute. In dual chambers devices, algorithms for preservation of spontaneous ventricular conduction were programmed. Results: Out of 930 TAVI patients (Sapien-3, n=374; Sapien-XT, n=513; Corevalve, n=43), 87 (9,4%) underwent PPI. Among them, 80 patients were analysed (lack of data in 5, death before pacemaker control in 2). The incidence of patients with a VP rate ≥1% according to PPI indications is shown in Table 1. In the group of patients implanted because of a new-onset persistent left bundle branch block (NOP-LBBB) with either prolonged HV interval (>70ms) or prolonged PR interval, in which half of them had a VP rate ≥1%, no clinical predictive factors for significant VP percentage were found.
A. Polewczyk 1 , W. Jachec 2 , M. Polewczyk 3 , A. Tomasik 2 , M. Janion 1 , A. Kutarski 4 . 1 The Jan Kochanowski University; Swietokrzyskie Cardiology Center, Faculty of Medicine and Health Sciences, 2nd Department of Cardiology, Kielce, Poland; 2 Medical University of Silesia, School of Medicine with the Division of Dentistry in Zabrze, 2nd Department of Cardiology, Zabrze, Poland; 3 Swietokrzyskie Cardiology Center, Acute Cardiac Care Unit, Kielce, Poland; 4 Medical University of Lublin, Department of Cardiology, Lublin, Poland Background: Transvenous lead extraction (TLE) is the gold standard in the management of patients with cardiac implantable electronic devices (CIED) -related complications. Objective: The evaluation of the effect of potential risk factors on the incidence of major and minor complications (MJC and MIC) as well as periprocedural and 30-day mortality following TLE. Methods: Clinical data from 1915 patients undergoing TLE at the Reference Center between 2006 and 2015 were analyzed. Indications for TLE included cardiac device infections (CDI) in 773 (41.3%) patients and noninfectious indications (NI) in 1142 (58.7%) patients. We evaluated the effect of clinical and procedure-related factors on the development of MJC and MIC, periprocedural and 30-day death rate following TLE. Results: MJC were caused mainly by lead implant duration, extraction of abandoned leads, removal of atrial leads and multiple preceding procedures. Of clinical factors, female gender and anemia increased the risk for developing MJC. MIC was reported in patients with sternotomy, intracardiac lead abrasion (ILA), malposition of the lead in the left ventricle (cardiac vein) and in patients with anemia. Multivariate analysis demonstrated a significant effect of clinical factors and CDI on 30-day mortality following TLE.
Table 1 Indications for PPI (number of patients) All patients (80) CAVB (51) Persistent CAVB (21) Paroxysmal CAVB (30) 2:1 atrioventricular block (4) NOP-LBBB with prolonged PR interval (18) NOP-LBBB with prolonged HV interval (5) Another indications (2)
Patients with ventricular pacing rate ≥1% 75% 90.2% 100% 83.3% 25% 50% 60% 50%
CAVB = complete atrioventricular block; NOP-LBBB = new-onset persistent left bundle branch block; PPI = permanent pacemaker implantation.
Risk factors of TLE complications
Conclusions: Efficacy and safety of TLE depend mainly on procedure-related factors: lead implant duration, type of extracted leads and the number of preceding procedures. This knowledge is essential for preventing MJC and MIC. Mortality at 30 days following TLE has no direct relationship with the procedure itself and is mainly associated with the clinical factors, CDI and the presence of MIC.
P1665 | BEDSIDE Chronic apical and non-apical right ventricular pacing in patients with high-grade atrioventricular block: results of the right pace study
Conclusion: PPI performed in the setting of complete atrioventricular block following TAVI is associated with a high VP rate during follow-up. In patients implanted for a NOP-LBBB with prolonged HV or PR interval, a significant VP rate (≥1%) was observed in up to half of them. Pending further studies to better determine PPI indications following TAVI, our results suggest PPI should be considered in these subsets of patients.
G.L. Botto 1 , G. Maglia 2 , V. Calvi 3 , D. Pecora 4 , D. Porcelli 5 , A. Costa 6 , G. Ciaramitaro 7 , R. Airo’ Farulla 8 , A. Rago 9 , R. Calvanese 10 , M.T. Baratto 11 , A. Reggiani 12 , M. Giammaria 13 , S. Patane’ 14 , C. Muto 15 . 1 Sant’Anna Hospital, Como, Italy; 2 Civil Hospital of Pugliese, Catanzaro, Italy; 3 A.O.U.P. “Vittorio Emanuele” - Ospedale Ferrarotto, Catania, Italy; 4 Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy; 5 Ospedale San Pietro, Roma, Italy; 6 Sacred Heart Hospital of Negrar, Negrar-Verona, Italy; 7 University Hospital Paolo Giaccone, Palermo, Italy; 8 Hospital of Cefalu (Istituto San Raffaele G.Giglio), Cefalu, Italy; 9 Vincenzo Monaldi Hospital, Naples, Italy; 10 Santa Maria di Loreto Mare Hospital, Naples, Italy; 11 Versilia Hospital, Lido Di Camaiore, Italy; 12 Hospital Carlo Poma, Mantova, Italy; 13 Maria Vittoria Hospital, Turin, Italy; 14 A.O. Papardo, Messina, Italy; 15 S. Maria della Pietà Hospital, Nola, Italy Background/Introduction: Chronic right ventricular apical (RVA) pacing is associated with an increased risk of atrial fibrillation, morbidity and even mortality. Non-RVA pacing may yield a more physiologic ventricular activation and provide potential long-term benefits. Non-RVA pacing has recently been adopted as standard procedure at many implanting centers. Purpose: The aim of the study was to compare the two approaches to chronic RV pacing currently adopted in clinical practice: RVA and non-RVA pacing. Methods: The Right Pace study was a multi-center, prospective, single-blind,
