Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations.

Husser, Oliver; Pellegrini, Costanza; Kim, Won-Keun; Holzamer, Andreas; Pilgrim, Thomas; Toggweiler, Stefan; Schäfer, Ulrich; Blumenstein, Johannes; Deuschl, Florian; Rheude, Tobias; Joner, Michael; Hilker, Michael; Hengstenberg, Christian; Möllmann, Helge

doi:10.1016/j.jcin.2019.05.055

journal article

Titel:: Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations.
Dokumenttyp:: Journal Article
Autor(en):: Husser, Oliver; Pellegrini, Costanza; Kim, Won-Keun; Holzamer, Andreas; Pilgrim, Thomas; Toggweiler, Stefan; Schäfer, Ulrich; Blumenstein, Johannes; Deuschl, Florian; Rheude, Tobias; Joner, Michael; Hilker, Michael; Hengstenberg, Christian; Möllmann, Helge
Abstract:: OBJECTIVES: This study sought to evaluate the impact of the ACURATE neo (NEO) (Boston Scientific, Marlborough, Massachusetts) versus SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) on permanent pacemaker implantation (PPI) in patients with pre-existing right bundle branch block (RBBB) after transcatheter aortic valve replacement. BACKGROUND: Pre-existing RBBB is the strongest patient-related predictor for PPI after transcatheter aortic valve replacement. No comparison of newer-generation transcatheter heart valves with regard to PPI in these patients exists. METHODS: This multicenter registry includes 4,305 patients; 296 (6.9%) had pre-existent RBBB and no pacemaker at baseline and formed the study population. The primary endpoint was new PPI at 30 days. The association of NEO versus S3 with PPI was assessed using binary logistic regression analyses and inverse probability treatment weighting in a propensity-matched population. RESULTS: The 30-day PPI rate was 39.2%. The S3 and NEO were used in 66.9% and 33.1%, respectively. The NEO was associated with lower rates of PPI compared with the S3 (29.6% vs. 43.9%; p = 0.025; odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.32 to 0.89; p = 0.018), after multivariable adjustment (OR: 0.48; 95% CI: 0.26 to 0.86; p = 0.014), and in the inverse probability treatment weighting analysis (OR: 0.37; 95% CI: 0.25 to 0.55; p < 0.001). There was no difference in device failure (8.2% vs. 6.6%; p = 0.792) or in-hospital course. In the propensity-matched population, PPI rate was also lower in the NEO versus S3 (23.1% vs. 44.6%; p = 0.016; OR: 0.37; 95% CI: 0.17 to 0.78; p = 0.010), with no difference in device failure (9.2% vs. 6.2%; p = 0.742). CONCLUSIONS: In patients with RBBB, risk of PPI was significantly lower with the NEO compared with the S3, suggesting the possibility of a patient tailored transcatheter heart valve therapy.
Zeitschriftentitel:: JACC Cardiovasc Interv
Jahr:: 2019
Band / Volume:: 12
Heft / Issue:: 18
Seitenangaben Beitrag:: 1781-1793
Volltext / DOI:: doi:10.1016/j.jcin.2019.05.055
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/31537278
Print-ISSN:: 1936-8798
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2019