More Complications When Pacemaker Required After TAVR

MedicalResearch.com Interview with:

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA Director of Research, Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre Senior Scientist, Sunnybrook Research Institute (SRI) Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)

Dr. Wijeysundera

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA
Director of Research, Division of Cardiology,
Schulich Heart Centre, Sunnybrook Health Sciences Centre
Senior Scientist, Sunnybrook Research Institute (SRI)
Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto
Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)
Toronto, ON, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the most common complications post TAVR is the need for a permanent pacemaker.  It is unclear if the need for a pacemaker is associated with long term adverse outcomes.

Using a population level registry of all TAVR procedures in ontario, canada, we found that pacemakers were required in ~15% of cases.  Requiring a pacemaker was associated with worse long term outcomes, including death, readmission to hospital and emergency room visits. 

MedicalResearch.com: What should readers take away from your report?

Response: The implications for clinicians are:  this work reinforces that , independent of the prosthesis type, effort should be made by implanters to minimize the risk of requiring a pacemaker through techniques such as a higher implantation depth.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The implications for the field: in comparison to device/prothesis innovations that have dramatically reduced other TAVR complications (for example vascular injury via smaller sheath sizes, and paravalvular leak via numerous technological advances such as cuffs/skirts), there has been a relative paucity of such device improvements specifically targeting a reduction in  conduction abnormalities and pacemaker need post TAVR.  This work is a call that such innovation is needed to reduce this important complication.

Disclosures: I received research funding from Medtronic inc and Edwards Life Sciences.

Citation:

Aljabbary T, Qiu F, Masih S, et al. Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JAMA Network Open. 2018;1(1):e180088. doi:10.1001/jamanetworkopen.2018.0088

 

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