Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve

Sarah Zaman, Liam McCormick, Robert Gooley, Hashrul N.Z. Rashid, Satish Ramkumar, Damon Jackson, Samuel Hui, Ian T. Meredith

Research output: Contribution to journalArticleResearchpeer-review

11 Citations (Scopus)

Abstract

Objectives: To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded LotusTM Valve System (Boston Scientific). Background: Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single-centre. Patients with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30-day incidence of pacemaker requirement (PPM implantation or death while pacing-dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results: A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre-existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty-day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0–5.7; P = 0.045). Conclusions: Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre-existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors.

Original languageEnglish
Pages (from-to)147-154
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume90
Issue number1
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • aortic valve disease
  • electron beam CT/multidetector CT
  • imaging
  • percutaneous intervention
  • transcatheter valve implantation

Cite this

@article{d31a230993224d4784b4e555ff9460f9,
title = "Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve",
abstract = "Objectives: To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded LotusTM Valve System (Boston Scientific). Background: Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single-centre. Patients with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30-day incidence of pacemaker requirement (PPM implantation or death while pacing-dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results: A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9{\%}) with a pre-existing PPM excluded. New or worsened procedural LBBB occurred in 78{\%}. Thirty-day incidence of the primary pacing endpoint was 28{\%}. The most common indication for PPM implantation was complete heart block (CHB) (69{\%}). Independent predictors of the primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95{\%} CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95{\%} CI 1.0–5.7; P = 0.045). Conclusions: Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre-existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors.",
keywords = "aortic valve disease, electron beam CT/multidetector CT, imaging, percutaneous intervention, transcatheter valve implantation",
author = "Sarah Zaman and Liam McCormick and Robert Gooley and Rashid, {Hashrul N.Z.} and Satish Ramkumar and Damon Jackson and Samuel Hui and Meredith, {Ian T.}",
year = "2017",
month = "7",
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doi = "10.1002/ccd.26857",
language = "English",
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journal = "Catheterization and Cardiovascular Interventions",
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Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve. / Zaman, Sarah; McCormick, Liam; Gooley, Robert; Rashid, Hashrul N.Z.; Ramkumar, Satish; Jackson, Damon; Hui, Samuel; Meredith, Ian T.

In: Catheterization and Cardiovascular Interventions, Vol. 90, No. 1, 01.07.2017, p. 147-154.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve

AU - Zaman, Sarah

AU - McCormick, Liam

AU - Gooley, Robert

AU - Rashid, Hashrul N.Z.

AU - Ramkumar, Satish

AU - Jackson, Damon

AU - Hui, Samuel

AU - Meredith, Ian T.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objectives: To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded LotusTM Valve System (Boston Scientific). Background: Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single-centre. Patients with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30-day incidence of pacemaker requirement (PPM implantation or death while pacing-dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results: A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre-existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty-day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0–5.7; P = 0.045). Conclusions: Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre-existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors.

AB - Objectives: To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded LotusTM Valve System (Boston Scientific). Background: Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single-centre. Patients with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30-day incidence of pacemaker requirement (PPM implantation or death while pacing-dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results: A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre-existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty-day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0–5.7; P = 0.045). Conclusions: Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre-existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors.

KW - aortic valve disease

KW - electron beam CT/multidetector CT

KW - imaging

KW - percutaneous intervention

KW - transcatheter valve implantation

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