Pacemaker memory in post‐TAVI patients: Who should benefit from permanent pacemaker implantation?

Abstract

In the post-TAVI period, our data support PPI in patients with CAVB even if paroxysmal. Our data also suggest PPI may be considered in patients with NOP-LBBB associated with either prolonged PR or HV interval.

Evolution of high‐grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode—that minimizes ventricular pacing—activated

“…A total of 273 patients with SafeR mode activated were enrolled. The characteristics of the study population are presented in STIM-TAVI study also highlights that many other classical predictors for late atrioventricular conduction disorders-which actually have been reported as being associated with a higher rate of pacemaker implantation and/or a higher ventricular pacing dependency [14][15][16][17][18] -had finally no significant influence on the occurrence of late high-grade atrioventricular block. We may hypothesize that F I G U R E 2 STIM-TAVI flow chart.…”

“…Data were entered into an electronic case report form. The main factors identified in the literature [4][5][6][7][8][9][10][11][12][14][15][16]18,22 as potentially associated with a higher risk of high-grade atrioventricular block after TAVI were systematically collected: presence of important valvular calcifications (on echocardiography or cardiac computed tomography), complete right bundle branch block before TAVI, type of implanted prosthesis (self-expanding or balloon-expandable), prosthesis implantation height (distance between the lower edge of the non-coronal cusp and the lower edge of the prosthesis [on its ventricular side] by angiography, defined as high if it was ≤6 mm or low if it was greater than 6 mm), use of an oversized prosthesis or balloon (larger than the manufacturer's instructions or when the balloon was larger than the size of the ring measured on preoperative cardiac computed tomography), new (≥120 ms) or wider (lengthening of QRS duration ≥20 ms and QRS ≥ 120 ms) left bundle branch block plus lengthening of the PR interval (≥40 ms) on Day 0 and/or Day 1, and early (within 6 days) high-grade atrioventricular block episodes. 23 Among patients who underwent an electrophysiological study, HV interval was also systematically collected.…”

“…We compared our endpoint (pacemaker-diagnosed late high-grade atrioventricular blocks) to the criterion most frequently used as a surrogate of abnormal atrioventricular conduction after TAVI (percentage of ventricular pacing, using a less than 1% cut-off value), 14,16 by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this criterion (collected at the 1-year follow-up visit) to predict the presence of ≥1 late high-grade atrioventricular block episode.…”

“…TAVI, transcatheter aortic valve implantation those traditional predictors reported so far may increase the risk of early atrioventricular conduction disorders (and therefore influence the decision to implant a pacemaker), but do not necessarily increase the risk of late high-grade atrioventricular block in case of eventless early period. 24 As discussed above, our methodology differs significantly from previous studies based on the "simple" percentage of ventricular pacing, [14][15][16][17][18] and this should have allowed more accurate identification of the principal parameters influencing late atrioventricular block. 20,21 However, traditional predictors described to date may be useful to guide and optimize patient management after TAVI, especially to identify those who need to have longer cardiac monitoring, but probably should not lead to systematic pacemaker implantation.…”

“…[6][7][8][9][10][11][12][13] Based on the percentage of ventricular pacing, several studies have suggested the recovery of atrioventricular conduction (with definitions varying across studies) during follow-up in 17%-31% of patients. [14][15][16][17][18] Such evaluation of atrioventricular conduction-using as surrogate the percentage of ventricular pacing-remains debatable, as some patients with apparently no need for ventricular pacing (ventricular pacing <1%), are potentially at risk of syncope or even sudden cardiac death due to paroxysmal high-grade atrioventricular block episodes. This traditional approach may overestimate ventricular pacing dependence, especially if a traditional dual chamber pacing mode is used.…”