In:
Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 14 ( 2018-07-17)
Abstract:
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 RVP s 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.
Type of Medium:
Online Resource
ISSN:
2047-9980
DOI:
10.1161/JAHA.118.009038
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
2653953-6
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