Université de Rennes 1 Impact pronostique de la stimulation cardiaque définitive après remplacement valvulaire aortique percutané Prognostic impact of permanent pacemaker implantation following transcatheter aortic valve replacement TAVIstimulateur cardiaqueinsuffisance cardiaque TAVRpermanent pacemakerheart failure TAVI (médecine) Insuffisance cardiaque Stimulateurs cardiaques Pronostic (médecine) Objectives: To determine the prognostic impact of permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR), according to the timing of implantation relative to TAVR. Background: Conduction disturbances requiring PPI remain a common complication of TAVR. The management of increasingly younger and less comorbid patients implies a need to better clarify the long-term impact of PPI. Methods: A total of 1199 patients (median age: 83 years old [78-86], 45.8% female) were included in the analysis, among whom 894 had no PPI (no-PPI), 130 had a previous PPI (p-PPI), 116 received in-hospital PPI (IH-PPI), and 59 received PPI during follow-up (FU-PPI). Median follow-up was 2.94 (1.42-4.32 years) years. The primary outcome was the composite of all-cause mortality and hospitalization for heart failure (HHF). Results: IH-PPI was performed for HAVB in 86.2% of patients, mostly with dual chamber pacemakers (68.1%). FU-PPI was performed at a median time of 1.7 (0.5-2.8) years post-TAVR. Most devices were dual chamber, yet 16.9% of patients received cardiac resynchronization therapy. FU-PPI was associated with a higher occurrence of the primary outcome (hazard ratio [HR]: 2.11, 95% confidence interval [CI]: 1.39-3.20) whereas P-PPI and IH-PPI were not (HR: 0.96, 95%CI: 0.71-1.29, and HR:1.26, 95%CI: 0.88-1.81, respectively). FU-PPI associated with a significantly higher risk of HHF (sub HR: 3.21, 95%CI: 2.02-5.11) while this relation was only borderline significant for PPPI (sub HR: 1.51, 95%CI: 0.99-2.29). In contrast, there was no relationship between IH-PPI and the subsequent risk of HHF. LVEF increased over time among no-PPI and P PPI patients while it nonsignificantly decreased from discharge to follow-up in IH-PPI and FU-PPI patients. Conclusions: P-PPI and IH-PPI had no long-term prognostic impact on the risk of all-cause mortality and HHF, whereas FU-PPI associated with a higher risk of HHF. The present study questions the deleterious influence of periprocedural post-TAVR PPI, which has previously been suggested by certain studies. Whether FU-PPI recipients represent patients, particularly sensitive to chronic right ventricular pacing should be the focus of further studies. Electronic Thesis or DissertationText en application/pdf1 : 4389 Kohttps://ged.univ-rennes1.fr/nuxeo/site/esupversions/186d6cc7-45be-4706-99f4-155f300e6cab Sharobeem Sam 1992-05-22 FR 260744530 sam.sharobeem@gmail.com 2021REN1M157 http://www.theses.fr/2021REN1M157 2021-10-04 Médecine Universite de Rennes 1thesis.degree.grantor_1 02778715X Doctorat (thèse d'exercice) non ouiAuffretVincentintervenant_1175043450 ddc:610 AuffretVincentUniversite de Rennes 1Sciences et technologie, medecine, pharmacie, odontologie, droit, economie, gestion, philosophie ASCII PDF 4493971 restriction 2021-10-04 2022-10-04 restriction 2021-10-04 2022-10-04