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Vol. 58. Issue 3.
Pages 208-218 (July - September 2023)
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Vol. 58. Issue 3.
Pages 208-218 (July - September 2023)
Original article
Performance of the 2019 consensus algorithm on the management of conduction disturbances after TAVI in clinical practice
Rendimiento del algoritmo de consenso de 2019 sobre alteraciones de la conducción tras el implante de TAVI en la práctica clínica
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Mariana Ribeiro Silva
Corresponding author
marianardsilva@gmail.com

Corresponding author.
, Alberto Rodrigues, Pedro Braga, Cláudio Guerreiro, Ana Mosalina Manuel, Gustavo Pires Morais, Bruno Melica, Lino Santos, João Almeida, Paulo Fonseca, Marco Oliveira, Helena Gonçalves, João Primo, Sílvia Diaz, Francisco Sampaio, Ricardo Fontes-Carvalho
Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
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Tables (3)
Table 1. Baseline clinical and procedural characteristics of the population.
Table 2. Baseline clinical and procedural characteristics regarding early-discharge eligibility.
Table 3. Group allocation for non-early-discharge candidates.
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Additional material (1)
Abstract
Introduction and objectives

Conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) increase the risk of permanent pacemaker (PPM) implantation and often preclude early-discharge (ED). The aim of this study was to evaluate the performance of the 2019 consensus algorithm on the management of conduction disturbances post-TAVI in a real-world cohort.

Methods

Retrospective analysis of patients who underwent transfemoral TAVI between 2016 and 2018. Patients with prior PPM were excluded. The algorithm classified patients as ED or non-ED candidates (due to a higher risk for high-degree atrioventricular block or because they were eligible for PPM). ED was defined as discharge at day-3 post-TAVI. Primary endpoint was the 30-day rate of PPM implantation and secondary endpoints included 6-month pacing rate, 1-year rate of syncope and all-cause mortality and the composite outcome of both, regarding ED eligibility.

Results

A total of 220 patients were included. The algorithm classified 66% of the patients as ED candidates. The 30-day rate of PPM implantation was 3.6% for ED candidates (vs 62.5% for non-ED candidates; P<.001). No differences were found in the secondary endpoints between ED and non-ED candidates. The algorithm identified 16% of the patients as eligible for PPM of whom 97.1% underwent PPM implantation; 18% of the patients were classified as at higher risk of high-degree atrioventricular block.

Conclusions

The 2019 algorithm allowed to safely ED a significant number of patients with conduction disturbances post-TAVI and to identify patients with a clear indication for PPM implantation. However, in high-risk patients, the algorithm does not provide a guiding strategy.

Keywords:
Transcatheter aortic valve implantation
Conduction disturbances
Permanent pacemaker
Discharge
Resumen
Introducción y objetivos

Los trastornos de la conducción tras el implante percutáneo de válvula aórtica (TAVI) incrementan el riesgo de necesidad de implante de marcapasos permanente (MP) y frecuentemente evitan un alta precoz (AP). El objetivo de nuestro estudio fue evaluar el rendimiento del algoritmo de consenso de 2019 en el tratamiento de los trastornos de la conducción post-TAVI en una cohorte real de pacientes.

Métodos

Análisis retrospectivo de pacientes que se sometieron a un TAVI transfemoral entre 2016 y 2018. Se excluyó a los pacientes que previamente habían sido portadores de MP. Se clasificó a los pacientes como candidatos a AP o no candidatos (en función del riesgo de bloqueo auriculoventricular de alto grado o la necesidad de implante de MP) según el algoritmo. Se definió el AP como el alta al tercer día post-TAVI. El objetivo principal fue la tasa a 30 días de implante de MP y los secundarios fueron la tasa a 6 meses de estimulación por MP, la tasa a un año de síncope y la mortalidad por cualquier causa.

Resultados

Se incluyó a un total de 220 pacientes. El 66% de los pacientes se consideró candidato a AP según el algoritmo. La tasa de implante de MP a 30 días fue de 3,6% para los candidatos a AP frente a 62,5% en los no candidatos (p<0,001). No se observaron diferencias en los objetivos secundarios entre los candidatos y no candidatos a AP. El 16% de los pacientes fueron candidatos a implante de MP, de los cuales el 97,1% se sometieron a dicho implante; el 18% de los pacientes se clasificó como en alto riesgo de bloqueo auriculoventricular de alto grado.

Conclusiones

El algoritmo de 2019 permite un AP segura en una parte significativa de los pacientes con trastornos de la conducción post-TAVI, así como la identificación de aquellos pacientes con indicación de implante de MP. Sin embargo, en pacientes de alto riesgo no es de ayuda en el tratamiento.

Palabras clave:
Implante percutáneo de válvula aórtica
Alteraciones de la conducción
Marcapasos permanente
Alta

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