Arrhythmia Occurrence After Balloon-Expandable and Self-Expanding Transcatheter Pulmonary Valve Replacement.
The incidence of arrhythmias after transcatheter pulmonary valve replacement (TPVR) beyond the early postprocedural period and their relationship to valve type (balloon-expandable [BEPVR] vs self-expanding [SEPVR] pulmonary valve replacement) have not been well defined.
The goal of this study was to assess the incidence, types, and timing of arrhythmias observed after BEPVR and SEPVR.
We retrospectively reviewed patients undergoing TPVR at our institution from 2012 to 2022 with rhythm monitoring beyond 14 days' postprocedure. The primary outcome was a composite of all-cause mortality and life-threatening arrhythmia. Secondary outcomes included non-life-threatening arrhythmias: nonsustained ventricular tachycardia (NSVT), atrial fibrillation, and other supraventricular tachycardias.
Sixty-eight patients (mean age 40.6 ± 16.4 years) were followed up for a median (IQR) of 4.0 (5.5) years after TPVR. Diagnoses included tetralogy of Fallot (45.6%), congenital pulmonary valve stenosis (23.5%), bicuspid aortic valve status-post Ross procedure (14.7%), and acquired pulmonary valve disease (7.4%). BEPVR was performed in 49 patients (72.1%) and SEPVR in 19 (27.9%). Life-threatening arrhythmias occurred in 13 patients (19.1%), all but one following BEPVR. NSVT was the most frequent non-life-threatening arrhythmia, observed in 47.1% of patients and significantly more common after SEPVR (P = 0.03). NSVT persisted beyond the early postprocedural period but was not associated with life-threatening arrhythmias or mortality.
Arrhythmias are common after TPVR beyond the early postimplantation period. No statistical difference could be determined for incidence of life-threatening arrhythmia or mortality between BEPVR or SEPVR. NSVT was the most observed arrhythmia and occurred significantly more often after SEPVR, independent of preimplantation arrhythmia history. Longer term studies are needed to determine the prognostic implication of NSVT after TPVR and the potential relationship to late life-threatening arrhythmias or mortality.
The goal of this study was to assess the incidence, types, and timing of arrhythmias observed after BEPVR and SEPVR.
We retrospectively reviewed patients undergoing TPVR at our institution from 2012 to 2022 with rhythm monitoring beyond 14 days' postprocedure. The primary outcome was a composite of all-cause mortality and life-threatening arrhythmia. Secondary outcomes included non-life-threatening arrhythmias: nonsustained ventricular tachycardia (NSVT), atrial fibrillation, and other supraventricular tachycardias.
Sixty-eight patients (mean age 40.6 ± 16.4 years) were followed up for a median (IQR) of 4.0 (5.5) years after TPVR. Diagnoses included tetralogy of Fallot (45.6%), congenital pulmonary valve stenosis (23.5%), bicuspid aortic valve status-post Ross procedure (14.7%), and acquired pulmonary valve disease (7.4%). BEPVR was performed in 49 patients (72.1%) and SEPVR in 19 (27.9%). Life-threatening arrhythmias occurred in 13 patients (19.1%), all but one following BEPVR. NSVT was the most frequent non-life-threatening arrhythmia, observed in 47.1% of patients and significantly more common after SEPVR (P = 0.03). NSVT persisted beyond the early postprocedural period but was not associated with life-threatening arrhythmias or mortality.
Arrhythmias are common after TPVR beyond the early postimplantation period. No statistical difference could be determined for incidence of life-threatening arrhythmia or mortality between BEPVR or SEPVR. NSVT was the most observed arrhythmia and occurred significantly more often after SEPVR, independent of preimplantation arrhythmia history. Longer term studies are needed to determine the prognostic implication of NSVT after TPVR and the potential relationship to late life-threatening arrhythmias or mortality.
Authors
McCanta McCanta, Bello Bello, Conley Conley, Petralia Petralia, Shah Shah, Zahn Zahn, Tompkins Tompkins
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