Left Ventricular Mechanical Dispersion as a Predictor of need for Pacemaker implantation after TAVI
The MeDiPace TAVI STUDY
Kaya E, Andresen K, Lie ØH, Aaberge L, Haugaa KH, Edvardsen T, Skulstad H
Conduction disturbances that require permanent pacemaker (PM) implantation are common after TAVI. Left ventricular (LV) mechanical dispersion by speckle tracking echocardiography is a marker of fibrosis, which can cause alterations in the conduction system. We hypothesized that LV mechanical dispersion can be a predictor of need for PM implantation after TAVI.
In this study, we consecutively enrolled 200 TAVI patients. Transthoracic echocardiography and electrocardiography examinations were recorded before TAVI to evaluate global longitudinal strain (GLS), LV mechanical dispersion and conduction disturbances. After TAVI, we collected the PM implantation information to detect the factors that are associated with it and tried to find the predictors of PM implantation. We found that LV mechanical dispersion predicted the need for PM after TAVI independently of GLS, QRS duration, RBBB and first-degree AV block. We also built a compound model of LV mechanical dispersion and RBBB to find the incremental predictive value of LV mechanical dispersion over RBBB.
The preliminary data was presented in the spring meeting of Norwegian society of cardiology in 2022 and was awarded with the best abstract prize. It was also presented in ESC 2022. Finally the study is published in the high impact journal Eur Heart J Cardiovascular Imaging in November 2023. We have also conducted a follow-up study on the same patient group, which is also soon to be submitted to relevant journals for publication.
