TAVI : qui et quand mettre un pace-maker ? C. GUENANCIA SERVICE DE - - PowerPoint PPT Presentation

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Mar 09, 2023 271 likes •559 views

TAVI : qui et quand mettre un pace-maker ? C. GUENANCIA SERVICE DE CARDIOLOGIE CHU DIJON Dclaration de Relations Professionnelles Disclosure Statement of Financial Interest J'ai actuellement, ou j'ai eu au cours des deux dernires

SLIDE 1

TAVI :à qui et quand mettre un pace-maker ?

C. GUENANCIA

SERVICE DE CARDIOLOGIE CHU DIJON

SLIDE 2

Déclaration de Relations Professionnelles Disclosure Statement of Financial Interest

None

I currently have, or have had over the last two years, an affiliation or financial interests or interests of any

rder with a company or I receive compensation or fees or research grants with a commercial company :

Affiliation/Financial Relationship

J'ai actuellement, ou j'ai eu au cours des deux dernières années, une affiliation ou des intérêts financiers ou intérêts de tout ordre avec une société commerciale ou je reçois une rémunération ou des redevances ou des octrois de recherche d'une société commerciale :

SLIDE 3

Conduction disorders : why ?

Nicolo Piazza et al, JACC: Cardiovascular Interventions, Volume 1, Issue 3, 2008, 310–316

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SLIDE 5

Auffret, V. et al. J Am Coll Cardiol. 2017;70(1):42–55.

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Permanent pacemaker implantation : predictive factors

Siontis et al. JACC 64:129-140 (2014)

SLIDE 7

PPI : prognostic value

Mohananey et al. Circ Cardiovasc Interv 2017;10

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2 critical questions !

? What ar are th the con

nduction ab

abnormali litie ies th that ab absolutely require th the plac lacement of

a devi vice? = = who ? ? ? When is is it it reas asonable to

lace a a pac acing devic ice? = When is is th the in inju jury ry to

the conduction system con

nsid

idered irr irreversib ible le?

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Pacemakers after TAVI : who ?

LBBB AV block

RBBB

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High degree AV block

50 to 70 % of patients will (at least partly) recover…

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Why ?

Bjerre Thygesen et al. J Invasive Cardiol 2014;26(2):94-99

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Predictors of long-term persistence of complete AVB

102 patients PPI after TAVI for CAVB 22% persistent CAVB at 1 year

Previous RBBB
Post dilatation
Higher mean aortic valve gradient

prior to implantation

27% Vpace <5%

Degree of acute AV block

Gaede et al. Clin Res Cardiol. 2018; 107:60–69

SLIDE 15

QRS duration and delayed AVB

Takahashi et al. http://dx.doi.org/10.1016/j.amjcard.2017.05.050

39% vs 0% !

SLIDE 16

Ando et al. Clin Cardiol. 39,9:544–550 (2016)

Left bundle branch block and pacemaker

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Left bundle branch block : evolution

Nishiyamaet al. Int J Cardiol. 227:25–29 (2017)

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LBBB and Delta PR >20 ms

EPS was performed a median of 6 (range 2–210, mean 13.3 ±38) days after TAVI

Tovia-Brodie et al. J Interv Card Electrophysiol (2017) 48:121–130

SLIDE 19

LBBB and Electro Physiologic Study

Rivard et al. Heart Rhythm 12:321–329 (2015) HV after TAVI >65 ms Delta-HV ≧13 ms

SLIDE 20

Naveh et al. J Cardiovasc Electrophysiol. 2016 Dec 12. doi: 10.1111/jce.13147

Permanent pacemaker implantation : predictive factors of PM indication at 1 year

SLIDE 21

RBBB without PM implantation

Auffret et al. JACC: Cardiovascular Interventions 2017

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Pacemaker after TAVI : when ?

Preexisting conductive disturbances (RBBB!):

Before ?
Early if additional conductive troubles

Auffret et al. Circulation. 2017;136:1049–1069.

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LBBB

Auffret et al. Circulation. 2017;136:1049–1069.

SLIDE 24

Auffret et al. Circulation. 2017;136:1049–1069.

AV BLOCK

> 48 h in ICU

SLIDE 25

Take-home messages

LBBB is associated with higher PPI rates and lower LVEF

Watchful waiting
Delta PR and QRS length !
EP study ?

RBBB without PM : careful !

SLIDE 26

Take-home messages

High Degree AVB

Preexisting conductive disturbances (RBBB++) ?
Post dilatation ?
Low rate of escape rhythm ?

If none of these criteria, wait at least 48 hours before PPI

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