Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement
Background Rapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long‐term clinical outcomes in a large coho...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009038 |
| _version_ | 1811332408852611072 |
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| author | Paul Fefer Andrada Bogdan Yoni Grossman Anat Berkovitch Yafim Brodov Rafael Kuperstein Amit Segev Victor Guetta Israel M. Barbash |
| author_facet | Paul Fefer Andrada Bogdan Yoni Grossman Anat Berkovitch Yafim Brodov Rafael Kuperstein Amit Segev Victor Guetta Israel M. Barbash |
| author_sort | Paul Fefer |
| collection | DOAJ |
| description | Background Rapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long‐term clinical outcomes in a large cohort of non‐selected TAVR patients. Method and Results The study included 412 consecutive patients undergoing TAVR with a mean age of 82±7 years, of which 47% were male. Patients were divided according to the number of RVPs during the TAVR procedure comparing patients undergoing no pacing (0), 1 to 2, and ≥3 pacing episodes (3+). Patients undergoing 3+ pacing episodes were significantly more likely to develop new atrial fibrillation (5.6% versus 7.3% versus 15%, respectively, for 0, 1–2, and 3+ groups, P=0.047), acute kidney injury (AKI) (18% versus 18% versus 28%, respectively, P<0.001), prolonged procedural hypotension (0%, 16%, and 25%, respectively; P<0.001), and suffered greater in‐hospital mortality (1.7%, 1.7%, and 6.5%, respectively, P=0.045), and 1‐year mortality (11.1%, 7.7%, and 18%, respectively, P=0.015). Multivariate Cox regression analysis indicated that acute kidney injury (OR 3.27 [1.763–6.09], P<0.001), euroSCORE II (OR 1.06 per unit [1.01–1.12], P=0.03), and 3+ pacing episodes (OR 2.35 [1.18–4.7], P=0.02) were the only independent predictors for 1‐year mortality. Conclusions In patients undergoing TAVR, multiple RVP episodes and prolonged RVP duration are associated with adverse outcomes including short‐ and long‐term mortality. Thus, operators should attempt to minimize the use of RVP, especially in patients who are at risk for post‐procedural acute kidney injury. |
| first_indexed | 2024-04-13T16:35:26Z |
| format | Article |
| id | doaj.art-b4cfb0d617324c18947295907b041d3e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:35:26Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b4cfb0d617324c18947295907b041d3e2022-12-22T02:39:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-07-0171410.1161/JAHA.118.009038Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve ReplacementPaul Fefer0Andrada Bogdan1Yoni Grossman2Anat Berkovitch3Yafim Brodov4Rafael Kuperstein5Amit Segev6Victor Guetta7Israel M. Barbash8Leviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelLeviev Heart Center Sheba Medical Center Ramat Gan IsraelBackground Rapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long‐term clinical outcomes in a large cohort of non‐selected TAVR patients. Method and Results The study included 412 consecutive patients undergoing TAVR with a mean age of 82±7 years, of which 47% were male. Patients were divided according to the number of RVPs during the TAVR procedure comparing patients undergoing no pacing (0), 1 to 2, and ≥3 pacing episodes (3+). Patients undergoing 3+ pacing episodes were significantly more likely to develop new atrial fibrillation (5.6% versus 7.3% versus 15%, respectively, for 0, 1–2, and 3+ groups, P=0.047), acute kidney injury (AKI) (18% versus 18% versus 28%, respectively, P<0.001), prolonged procedural hypotension (0%, 16%, and 25%, respectively; P<0.001), and suffered greater in‐hospital mortality (1.7%, 1.7%, and 6.5%, respectively, P=0.045), and 1‐year mortality (11.1%, 7.7%, and 18%, respectively, P=0.015). Multivariate Cox regression analysis indicated that acute kidney injury (OR 3.27 [1.763–6.09], P<0.001), euroSCORE II (OR 1.06 per unit [1.01–1.12], P=0.03), and 3+ pacing episodes (OR 2.35 [1.18–4.7], P=0.02) were the only independent predictors for 1‐year mortality. Conclusions In patients undergoing TAVR, multiple RVP episodes and prolonged RVP duration are associated with adverse outcomes including short‐ and long‐term mortality. Thus, operators should attempt to minimize the use of RVP, especially in patients who are at risk for post‐procedural acute kidney injury.https://www.ahajournals.org/doi/10.1161/JAHA.118.009038outcomepacingtranscutaneous aortic valve implantation |
| spellingShingle | Paul Fefer Andrada Bogdan Yoni Grossman Anat Berkovitch Yafim Brodov Rafael Kuperstein Amit Segev Victor Guetta Israel M. Barbash Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease outcome pacing transcutaneous aortic valve implantation |
| title | Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement |
| title_full | Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement |
| title_fullStr | Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement |
| title_short | Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement |
| title_sort | impact of rapid ventricular pacing on outcome after transcatheter aortic valve replacement |
| topic | outcome pacing transcutaneous aortic valve implantation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009038 |
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