Predictive factors for pacemaker requirement after transcatheter aortic valve implantation

Abstract

BackgroundTranscatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI.MethodsBaseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done.ResultsTAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p<0.001), longer AH (153.6±43.4 msec versus 116.1±31.2 msec; p<0.001) and HV interval (81.7±17.8 msec versus 56.8±8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay.ConclusionCardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.

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

“…Akin et al. also found that a PR interval longer than 200 ms post‐TAVI was a predictive factor for the development of high degree AV block during follow‐up . These data suggest the potential importance of the PR interval as a predictor of pacemaker use.…”

Meta-Analysis of Predictors of All-Cause Mortality After Transcatheter Aortic Valve Implantation

“…Left ventricular ejection fraction (LVEF) was in general preserved, except for 3 studies in which mean LVEF was mildly compromised (range of mean LVEF 47% to 60%). 26,27,32 The most important baseline characteristics are reported in Table 1. 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 A small majority of patients were treated by the transfemoral approach (51.1%), followed by the transapical approach (33.7%), and only few patients received a direct aortic or trans-subclavian procedure (1.5% and 0.2%, respectively).…”

Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB–TAVI Study

“…[1][2][3] It is one of the most common complications of this procedure. LBBB is a marker of poor prognosis, with an increased risk of complete atrioventricular (AV) block, heart failure and sudden cardiac death.…”