TAVI: CONDUCTION DISORDERS AND ARRHYTHMIAS. Dr C. Guenancia Service de Cardiologie CHU Dijon

Transcription

1 TAVI: CONDUCTION DISORDERS AND ARRHYTHMIAS Dr C. Guenancia Service de Cardiologie CHU Dijon

2 Déclaration de Relations Professionnelles Disclosure Statement of Financial Interest J'ʹai actuellement, ou j'ʹai eu au cours des deux dernières années, une affiliation ou des intérêts financiers ou intérêts de tout ordre avec une société commerciale ou je reçois une rémunération ou des redevances ou des octrois de recherche d'ʹune société commerciale : I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Affiliation/Financial Relationship None

3 Conductive disorders : FRANCE 2 registry Vascular Complications, 9,7 Mortality, 9,7 Major Bleeding, 5,7 Stroke, 4,1 Pacemaker Implantation, 15,6 Gilard et al. N Engl J Med 366: (2012)

4 Conduction disorders : why?

5 Conduction disorders : why? Nicolo Piazza, Yoshinobu Onuma, Emile Jesserun, Peter Paul Kint, Anne-Marie Maugenest, Robert H. Anderson, Peter P. Th de Jaegere, Patrick W. Serruys Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve JACC: Cardiovascular Interventions, Volume 1, Issue 3, 2008,

6 Conduction disorders LBBB AV block

7 Left bundle branch block : incidence

8 Left bundle branch block : incidence Van der Boon et al. Catheterization and Cardiovascular Interventions 85: (2015)

9 Edwards SAPIEN XT / Medtronic CoreValve

10 Left bundle branch block : predictive factors Van der Boon et al. Catheterization and Cardiovascular Interventions 85: (2015) Boerlage- Van Dijk et al. PACE 37: (2014)

11 Left bundle branch block : prognostic value Houthuizen et al. EuroIntervention 9: (2014)

12 Left bundle branch block: prognostic value Urena et al. JACC Cardiovascular Interventions. 7: (2014)

13 Left bundle branch block and pacemaker Urena et al. JACC Cardiovascular Interventions. 7: (2014)

14 Left bundle branch block and AV block Independent predictors of AV block after LBBB post TAVI Delta HV > =13 ms Or HV after TAVI > 65 ms Rivard et al. Heart Rhythm 12: (2015)

15 Left bundle branch block and AV block Rivard et al. Heart Rhythm 12: (2015)

16 Permanent pacemaker implantation : incidence

17 Permanent pacemaker implantation : incidence Buellesfeld et al. JACC 60: (2012)

18 Siontis et al. JACC 64: (2014) Permanent pacemaker implantation : predictive factors

19 Permanent pacemaker implantation : predictive factors Siontis et al. JACC 64: (2014)

20 Permanent pacemaker implantation : new generation valves Accutrak Mouillet et al. Catheterization and Cardiovascular Interventions 86:E158 E166 (2015)

21 Permanent pacemaker implantation : new generation valves Edwards Sapien 3 vs XT Tarantini et al. EuroIntervention /EIJY14M11_

22 Permanent pacemaker implantation: new generation valves

23 Permanent pacemaker implantation: prognostic value Mouillet et al. Catheterization and Cardiovascular Interventions 86:E158 E166 (2015) Buellesfeld et al. JACC 60: (2012)

24 Permanent pacemaker implantation and heart failure Mouillet et al. Catheterization and Cardiovascular Interventions 86:E158 E166 (2015)

25 Permanent pacemaker implantation : follow-up

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27 TAVI and atrial fibrillation Common in TAVI population : >10% after 80 years 25-35% in elderly patients with severe degenerative aortic stenosis Classical prognostic factor after surgical aortic valve replacement (SAVR) Pre-existing New-onset Less common after TAVI? Prognostic value?

28 Atrial fibrillation : incidence FRANCE 2 1 : 3933 patients ,8% pre existing AF 6% of new-onset AF Amat-Santos et al 2 : 138 patients (ESV) with no pre existing AF 44 (32%) new-onset AF > 6% or 32 %? Depends on the screening : ECG vs continuous monitoring! 1 Chopard et al. JACC: Cardiovascular Interventions 8: (2015) 2 Amat-Santos et al. JACC 59: (2012)

29 Atrial fibrillation : incidence Amat-Santos et al. JACC 59: (2012)

30 Atrial fibrillation : predictive factors Chopard et al. JACC: Cardiovascular Interventions 8: (2015)

31 Atrial fibrillation : prognostic value Chopard et al. JACC: Cardiovascular Interventions 8: (2015)

32 Atrial fibrillation : prognostic value Chopard et al. JACC: Cardiovascular Interventions 8: (2015)

33 Atrial fibrillation and stroke Amat-Santos et al. JACC 59: (2012)

34 Atrial fibrillation recurrences Amat-Santos et al. JACC 59: (2012)

35 Conclusion LBBB and AF have a strong prognostic value after TAVI Close follow-up PPI rates are high, how to reduce? Implantation depth? Watchful waiting? AAI <--> DDD algorithms Preexisting LBBB and reduced LVEF : CRT before TAVI? CRTAVI (PHRC) 2016 Dr EICHER (Dijon)

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