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| Impact pronostique de la stimulation cardiaque définitive après remplacement valvulaire aortique percutané (Prognostic impact of permanent pacemaker implantation following transcatheter aortic valve replacement) Sharobeem, Sam - (2021-10-04) / Universite de Rennes 1 - Impact pronostique de la stimulation cardiaque définitive après remplacement valvulaire aortique percutané
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Langue : Anglais Directeur(s) de thèse: Auffret, Vincent Discipline : Médecine Classification : Médecine et santé Mots-clés : TAVI, stimulateur cardiaque, insuffisance cardiaque
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Résumé : 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. Abstract : | |||