Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications
<i>Background and Objectives</i>: Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve replacement (TAVR). Dual antiplatelet therapy (DAPT) or oral anticoagulation therapy (OAK) is often necessary in these patients since they are at higher ri...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/12/1331 |
| _version_ | 1797502570161242112 |
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| author | Alexander Lind Majid Ahsan Elif Kaya Reza Wakili Tienush Rassaf Rolf Alexander Jánosi |
| author_facet | Alexander Lind Majid Ahsan Elif Kaya Reza Wakili Tienush Rassaf Rolf Alexander Jánosi |
| author_sort | Alexander Lind |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve replacement (TAVR). Dual antiplatelet therapy (DAPT) or oral anticoagulation therapy (OAK) is often necessary in these patients since they are at higher risk of thromboembolic events due to TAVR implantation, high incidence of coronary artery diseases (CAD) with the necessity of coronary intervention, and high rate of atrial fibrillation with the need of stroke prevention. We sought to evaluate the safety, efficiency, and clinical outcomes of early PPI following TAVR using the PlasmaBlade™ (Medtronic Inc., Minneapolis, MN, USA) pulsed electron avalanche knife (PEAK) for bleeding control in patients under DAPT or OAK. <i>Materials and Methods</i>: This retrospective single-center study included patients who underwent PPI after transfemoral TAVR (TF) at our center between December 2015 and May 2020. All PPI were performed using the PlasmaBlade™ Device. <i>Results</i>: The overall PPI rate was 14.1% (83 of 587 patients; 82.5 ± 4.6 years; 45.8% male). The PPI procedures were used to treat high-grade atrioventricular block (81.9%), severe sinus node dysfunction (13.3%), and alternating bundle branch block (4.8%). At the time of the procedure, 35 (42.2%) patients received DAPT, and 48 (57.8%) patients received OAK (50% with vitamin K antagonist (VKA) and 50% with novel oral anticoagulants (NOAK)). One device-pocket hematoma treated conservatively occurred in a patient (1.2%) receiving NOAK. Two re-operations were necessary in patients due to immediate lead dislocation (2.4%). <i>Conclusions</i>: The results of this study illustrate that the use of PlasmaBlade™ for PPI in patients after a TAVR who require antithrombotic treatment is feasible and might result into lower rates of severe bleeding complications compared to rates reported in the literature. Use of the PlasmaBlade device may be considered in this specific group of patients because of their high risk of bleeding. |
| first_indexed | 2024-03-10T03:35:58Z |
| format | Article |
| id | doaj.art-37d702a502d2405f83068389926c4630 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T03:35:58Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-37d702a502d2405f83068389926c46302023-11-23T09:28:29ZengMDPI AGMedicina1010-660X1648-91442021-12-015712133110.3390/medicina57121331Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding ComplicationsAlexander Lind0Majid Ahsan1Elif Kaya2Reza Wakili3Tienush Rassaf4Rolf Alexander Jánosi5Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, 45147 Essen, Germany<i>Background and Objectives</i>: Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve replacement (TAVR). Dual antiplatelet therapy (DAPT) or oral anticoagulation therapy (OAK) is often necessary in these patients since they are at higher risk of thromboembolic events due to TAVR implantation, high incidence of coronary artery diseases (CAD) with the necessity of coronary intervention, and high rate of atrial fibrillation with the need of stroke prevention. We sought to evaluate the safety, efficiency, and clinical outcomes of early PPI following TAVR using the PlasmaBlade™ (Medtronic Inc., Minneapolis, MN, USA) pulsed electron avalanche knife (PEAK) for bleeding control in patients under DAPT or OAK. <i>Materials and Methods</i>: This retrospective single-center study included patients who underwent PPI after transfemoral TAVR (TF) at our center between December 2015 and May 2020. All PPI were performed using the PlasmaBlade™ Device. <i>Results</i>: The overall PPI rate was 14.1% (83 of 587 patients; 82.5 ± 4.6 years; 45.8% male). The PPI procedures were used to treat high-grade atrioventricular block (81.9%), severe sinus node dysfunction (13.3%), and alternating bundle branch block (4.8%). At the time of the procedure, 35 (42.2%) patients received DAPT, and 48 (57.8%) patients received OAK (50% with vitamin K antagonist (VKA) and 50% with novel oral anticoagulants (NOAK)). One device-pocket hematoma treated conservatively occurred in a patient (1.2%) receiving NOAK. Two re-operations were necessary in patients due to immediate lead dislocation (2.4%). <i>Conclusions</i>: The results of this study illustrate that the use of PlasmaBlade™ for PPI in patients after a TAVR who require antithrombotic treatment is feasible and might result into lower rates of severe bleeding complications compared to rates reported in the literature. Use of the PlasmaBlade device may be considered in this specific group of patients because of their high risk of bleeding.https://www.mdpi.com/1648-9144/57/12/1331bleedingTAVRanticoagulationpacemakerclopidogrelantiplatelet therapy |
| spellingShingle | Alexander Lind Majid Ahsan Elif Kaya Reza Wakili Tienush Rassaf Rolf Alexander Jánosi Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications Medicina bleeding TAVR anticoagulation pacemaker clopidogrel antiplatelet therapy |
| title | Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications |
| title_full | Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications |
| title_fullStr | Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications |
| title_full_unstemmed | Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications |
| title_short | Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications |
| title_sort | early pacemaker implantation after transcatheter aortic valve replacement impact of plasmablade™ for prevention of device associated bleeding complications |
| topic | bleeding TAVR anticoagulation pacemaker clopidogrel antiplatelet therapy |
| url | https://www.mdpi.com/1648-9144/57/12/1331 |
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