Pacing the Atrium to Confirm or Exclude Pacemaker Indication in TAVI

Study Overview
=================
Brief Summary
-----------------
The current observational registry aims to evaluate in patients undergoing TAVI implantation: the positive and negative predictive value for PPM post TAVI of Wenckebach phenomenona (WB) during RAP during the TAVI procedure, baseline and procedural characteristics of TAVI-implantation associated with new conduction abnormalities and need for PPM implantation, peri-procedural safety, in-hospital and 1-month outcomes after TAVI implantation.

Detailed Description
-----------------
The persistent growth in transcatheter aortic valve implantation (TAVI) calls for optimized early discharge programs to handle the increasing patient load. While access site bleeding and stroke rate have decreased with improved technologies and operators' experience, acquired conduction abnormalities necessitating prolonged rhythm-monitoring and permanent pacemaker (PPM) implantation have remained largely unchanged, and even up to 39.9% for some TAVI platforms. Prompt identification of patients necessitating PPM implantation leads to optimal patient care and use of resources. Conversely, prompt identification of patients with low -to no- risk for PPM post TAVI shortens their hospitalization and facilitates early and safe discharge. Several baseline characteristics such as age, preexistent right bundle branch block (RBBB) and the use of self-expanding valves are associated with post-TAVI PPM implantation, but more practical and clinically more relevant parameters are needed with high negative and positive predictive values that could support clinical decision-making. En passant rapid atrial pacing (RAP) immediately following TAVI has recently been reported to be a valuable tool in PPM risk stratification. The absence of Wenckebach phenomena post implantation at RAP up to 120/' has a negative predictive value for PPM of 98.7%.2 First use of RAP in routine practice at AZ Sint Jan Brugge can confirm these first results (unpublished data). This technique improves our clinical assessment and identification of low-risk patients for PPM suitable for safe early discharge, as well as high-risk patients requiring further rhythm monitoring and eventual PPM implantation. The current observational registry aims to evaluate in patients undergoing TAVI implantation: the positive and negative predictive value for PPM post TAVI of Wenckebach phenomenona (WB) during RAP during the TAVI procedure, baseline and procedural characteristics of TAVI-implantation associated with new conduction abnormalities and need for PPM implantation, peri-procedural safety, in-hospital and 1-month outcomes after TAVI implantation.

Official Title
-----------------
Pacing the Atrium to Confirm or Exclude Pacemaker Indication in TAVI: the PACE-TAVI Registry

Conditions
-----------------
Aortic Valve Stenosis

Intervention / Treatment
-----------------
* Procedure: RAP TAVI


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients in sinus rhythm with TAVI Exclusion Criteria: Patients in atrial fibrillation at the time of the implantation Patients with pre-existent pacemaker

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| RAP TAVI group<br>All patients in sinus rhythm with TAVI | Procedure: RAP TAVI<br>* All patients undergoing TAVI with no pre-existing pacemaker and in sinus rhythm at the time of the procedure will receive RAP by placing the temporary wire in the right atrium<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Positive and negative predictive value of RAP for PPM implantation post TAVI |  | 1 month after TAVI | 
| Permanent pacemaker implantation |  | 1 month after TAVI | 
| New conduction abnormalities |  | within 1 week after TAVI | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of hospitalization |  | 1 month after TAVI | 
| Echocardiographic changes |  | 1 month after TAVI | 
| Stroke |  | 1 month after TAVI | 
| Major vascular bleeding |  | 1 month after TAVI | 
| New pericardial effusion |  | 1 month after TAVI | 
| All-cause mortality |  | 1 month after TAVI |