Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System

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• 作者：Antonio J. Muñ ; oz-Garcí ; a ; MD ; PhD ; ^{ajmunozgarcia@secardiologia.es} ; José ; M. Herná ; ndez-Garcí ; a ; MD ; PhD ; Manuel F. Jimé ; nez-Navarro ; MD ; PhD ; Juan H. Alonso-Briales ; MD ; Antonio J. Domí ; nguez-Franco ; MD ; Julia Ferná ; ndez-Pastor ; MD ; Jose Peñ ; a Herná ; ndez ; MD ; Alberto Barrera Cordero ; MD ; Javier Alzueta Rodrí ; guez ; MD ; PhD ; Eduardo de Teresa-Galvá ; n ; MD ; PhD
• 关键词：aortic stenosis ; pacemakers ; prosthesis ; transcatheter aortic valve implantation
• 刊名：JACC ; Cardiovascular Interventions
• 出版年：2012
• 期刊代码：pca198_19368798
• 类别：med
• 出版时间：May, 2012
• 卷：5
• 期：5
• 页码：533-539
• 文件大小：342 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences<h4 class="h4">Objectivesh4>The purpose of this study was to evaluate the need for a permanent pacemaker after transcatheter aortic valve implantation with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) using the new Accutrak delivery system (Medtronic, Inc.).<h4 class="h4">Backgroundh4>

The need for a permanent pacemaker is a recognized complication after transcatheter aortic valve implantation with the CoreValve prosthesis.<h4 class="h4">Methodsh4>

Between April 23, 2008 and May 31, 2011, 195 consecutive patients with symptomatic aortic valve stenosis underwent transcatheter aortic valve implantation using the self-expanding CoreValve prosthesis. In 124 patients, the traditional delivery system was used, and in 71 patients, the Accutrak delivery system was used.<h4 class="h4">Resultsh4>

There were no significant differences in baseline electrocardiographic characteristics between the traditional system and the Accutrak patients: PR interval: 153 卤 46 mm versus 165 卤 30 mm, p = 0.12; left bundle branch block: 22 (20.2%) versus 8 (12.7%), p = 0.21; right bundle branch block: 21 (19.3%) versus 8 (12.7%), p = 0.26. The depth of the prosthesis in the left ventricular outflow tract was greater with the traditional system than with the Accutrak system (9.6 卤 3.2 mm vs. 6.4 卤 3 mm, p < 0.001) and the need for a permanent pacemaker was higher with traditional system than with Accutrak (35.1%vs. 14.3%, p = 0.003). The predictors of the need for a pacemaker were the depth of the prosthesis in the left ventricular outflow tract (hazard ratio [HR]: 1.2, 95%confidence interval [CI]: 1.08 to 1.34, p < 0.001), pre-existing right bundle branch block (HR: 3.5, 95%CI: 1.68 to 7.29, p = 0.001), and use of the traditional system (HR: 27, 95%CI: 2.81 to 257, p = 0.004).<h4 class="h4">Conclusionsh4>

The new Accutrak delivery system was associated with less deep prosthesis implantation in the left ventricular outflow tract, which could be related to the lower rate of permanent pacemaker requirement.