Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis

• Published in: Heart (British Cardiac Society) Vol. 97; no. 20; pp. 1687 - 1694
• Main Authors: Bagur, Rodrigo, Manazzoni, Juan Maria, Dumont, Éric, Doyle, Daniel, Perron, Jean, Dagenais, François, Mathieu, Patrick, Baillot, Richard, Charbonneau, Éric, Metrás, Jacques, Mohammadi, Siamak, Côté, Mélanie, Philippon, François, Voisine, Pierre, Rodés-Cabau, Josep
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.10.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Aortic stenosis; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - therapy; Biological and medical sciences; Cardiac arrhythmia; Cardiology; Cardiology. Vascular system; coronary intervention (PCI); elderly; Electrocardiography; Electrodes, Implanted; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart attacks; Heart surgery; Heart Valve Prosthesis - adverse effects; Hospitals; Humans; Incidence; interventional cardiology; Male; Medical sciences; Mortality; pacemaker implantation; Pacemaker, Artificial; percutaneous valve therapy; Population; Quebec - epidemiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Severity of Illness Index; Studies; Survival Rate - trends; Time Factors; transcatheter; Treatment Outcome; valve replacement; Variables; Quebec; Quebec City Quebec Canada; Human; Aortic stenosis; Permanent; Instrumentation therapy; Cardiovascular disease; Implantation; Patient; Replacement; In vitro; Instrumental stimulation; Cardiac valvular disease; Pacemaker; Circulatory system; Cardiology; Severe; Elderly; Aortic valve
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2011-300308

ObjectivesTo assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.Main outcome measuresThe incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p=0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p=0.12).ConclusionsThe need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.