RT Journal Article
SR Electronic
T1 Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1687
OP 1694
DO 10.1136/heartjnl-2011-300308
VO 97
IS 20
A1 Rodrigo Bagur
A1 Juan Maria Manazzoni
A1 Éric Dumont
A1 Daniel Doyle
A1 Jean Perron
A1 François Dagenais
A1 Patrick Mathieu
A1 Richard Baillot
A1 Éric Charbonneau
A1 Jacques Metrás
A1 Siamak Mohammadi
A1 Mélanie Côté
A1 François Philippon
A1 Pierre Voisine
A1 Josep Rodés-Cabau
YR 2011
UL http://heart.bmj.com/content/97/20/1687.abstract
AB Objectives To 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.Methods A 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 measures The incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.Results Baseline 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).Conclusions The 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.