Ventricular Conduction Defects After Transcatheter Aortic Valve Implantation: A Single‐Institute Analysis

Abstract

Patients with aortic stenosis tend to develop ventricular conduction problems, which are known adverse events following transcatheter aortic valve implantation (TAVI). Changes in ventricular conduction status after TAVI were analyzed in 195 consecutive patients from a single institute registered in FRANCE2 between February 2010 and June 2012. Among the 195 patients, 29 had a prior pacemaker implantation (+PM) and 6 had acute catastrophic hemodynamics that made a full electrocardiogram (ECG) unavailable. Among the remaining 160, PM was newly required in 28 (17.5%, PM+) but not in 132 (PM-), which included 21 (13.1%) who developed new left bundle branch block (BBB), 12 (7.5%) had right BBB, and 99 (61.9%) had no change. While PM requirement had no correlation with preoperative factors, there was significant association with the development of right BBB with Edwards Sapien/XT (P = 0.003), and new left BBB (P = 0.012) and complete heart block requiring PM with CoreValve (22.6% vs. Edwards Sapien/XT, 7.4%, P = 0.016). Whereas postoperative survival regarding PM status (+PM, PM+, PM-), vascular access, valve size or type showed no difference, delayed heart block (n = 12, Day 2 or later) was associated with poor survival (P = 0.038) compared with the remaining PM+ patients with earlier onset (n = 16, Day 0 or 1). As a result, PM+ patients (n = 28) had significantly longer intensive care unit (ICU) stay and hospitalization than PM- or +PM patients. The results suggest that ventricular conduction problems requiring PM occurred more frequently after TAVI (17.5%) than with usual surgical replacement. Nonetheless, conduction problems failed to influence postoperative survival for up to 3 years on average with use of PM, but therefore did increase medical costs.

Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

“…Our search yielded 23 studies [12][13][14]16,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] with 20 287 patients and 2553 PPM implantations published between the years 2010 and 2016 (Table). (Figure 2).…”

“…The center of the diamond represents the point estimate, and the width represents 95% confidence interval (CI). Studies included in these analyses are Fadahunsi et al, 12 Dizon et al, 13 Biner et al, 14 D'Ancona et al, 23 De Carlo et al, 24 Houthuizen et al, 25 Buellesfeld et al, 26 Van Mieghem et al, 28 Pereira et al, 30 Schymik et al, 32 Maan et al, 33 Kostopoulou et al, 34 Mouillet et al, 35 Engborg et al, 36 and Kawaguchi et al 37 …”

“…In addition, for calculation of improvement in LVEF, there were 3 studies 16,17,21 where SDs for change (improvement) in LVEF were not available. Here, we imputed the SD based on other studies in the meta-analysis with similar follow-up duration based on guidelines 12 Dizon et al, 13 Biner et al, 14 D'Ancona et al, 23 De Carlo et al, 24 Houthuizen et al, 25 Buellesfeld et al, 26 Van Mieghem et al, 28 Pereira et al, 30 Schymik et al, 32 Maan et al, 33 Kostopoulou et al, 34 Mouillet et al, 35 Engborg et al, 36 and Kawaguchi et al 37 CI indicates confidence interval; MH, Mantel-Haenszel; and PPM, permanent pacemaker. Impact of Post-TAVR Pacemaker for systematic reviews provided by the Cochrane Collaboration.…”

“…The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). Studies included in these analyses are Dizon et al, 13 Biner et al, 14 Urena et al, 16 Weber et al, 17 Carrabba et al, 21 Houthuizen et al, 25 Van Mieghem et al, 28 Gensas et al, 31 Kostopoulou et al, 34 Engborg et al, 36 and Kawaguchi et al 37 CI indicates confidence interval; MH, Mantel-Haenszel; and PPM, permanent pacemaker. Impact of Post-TAVR Pacemaker…”

Incidence and Predictors of Pacemaker Implant Post Commercial Approval of the CoreValve System for TAVR

“…[8][9][10][11][12][13][14][15][16][17]21,24,25 This may reflect differences in our population compared with the entire Pivotal Trial cohort or the general population post approval or perhaps a broader indication. The rate of high-grade AV block (complete heart block or Mobitz II second-degree block) was 22.9%.…”