AI Article Synopsis

  • * Optimize PRO, a prospective study, implements two strategies: using a cusp overlap technique during TAVR and a CD algorithm that assesses patients based on their post-procedure ECG for early discharge decisions.
  • * Results indicate that patients with conduction disturbances had a significantly higher PPI rate at 30 days compared to those without (28.1% vs 1.5%), but the standardized management of CDs led to similar safety outcomes, suggesting effective early recognition and monitoring of arrhythm

Article Abstract

Background: Lack of standardization in posttranscatheter aortic valve replacement (TAVR) conduction disturbance (CD) identification and treatment may affect permanent pacemaker implantation (PPI) rates and clinical outcomes. The safety and efficacy of a standardized TAVR CD algorithm has not been analyzed. This study analyzes the Optimize PRO post-TAVR CD management algorithm with Evolut PRO/PRO valves.

Methods: Optimize PRO is a prospective, postmarket study implementing 2 strategies to reduce pacemaker rates: TAVR with cusp overlap technique and a post-TAVR CD algorithm. The 2-hour postprocedural electrocardiogram (ECG) stratified patients to early discharge in the absence of new ECG changes or to CD algorithms for (1) ECG changes with preexisting right or left bundle branch block (LBBB), interventricular conduction delay or first-degree atrioventricular block, (2) new LBBB, or (3) high-degree atrioventricular block (HAVB).

Results: The interim analysis of the CD cohort consisted of 125/400 TAVR recipients. In the CD cohort, the 30-day new PPI rate was higher (28.1% vs 1.5%; <.001), and 60 (48%) patients were discharged with a 30-day continuous ECG monitor. At 30 days, 90% of patients discharged with a monitor did not require PPI. Clinical outcomes, including mortality, stroke, bleeding, and reintervention, were similar in patients with and without CDs. No patient experienced sudden cardiac death.

Conclusions: Effective management of CDs using a standard algorithm following Evolut TAVR provides similar 30-day safety outcomes to patients without CDs who undergo routine next day discharge. The CD algorithm may provide an effective strategy to recognize arrhythmias early, improve PPI utilization, and facilitate safe monitoring of patients after discharge.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307950PMC
http://dx.doi.org/10.1016/j.jscai.2023.101066DOI Listing

Publication Analysis

Top Keywords

optimize pro
12
ecg changes
8
block lbbb
8
atrioventricular block
8
management postprocedural
4
postprocedural conduction
4
conduction disturbances
4
disturbances prespecified
4
algorithm
4
prespecified algorithm
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!