title: Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation.
abstract: The objective of this study was to identify electrocardiographic (ECG) and further predictors for atrioventricular (AV) block with a need for pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI). Pre- and post-procedural ECGs of patients with severe aortic stenosis and ongoing TAVI were investigated in a prospective study. From 50 consecutive patients enrolled in the study (mean age 80 +/- 6 years, 46% men), 17 (34%) experienced an AV block with subsequent requirement of a permanent PM [16 of 36 (44.4%) with CoreValve System and 1 of 14 (7.1%) with Edwards Sapiens System]. In patients with right bundle branch block (RBBB), PM implantation had to be performed more frequently [6 of 6 (100%) with CoreValve System and none with Edwards Sapiens System], P = 0.005. An AV block (Mobitz II second degree and third degree) occurred mostly within the first 24 h (range: Days 0-13) after the index procedure. No recovery of AV conduction with a change in PM indication occurred in a mean follow-up time of 13 +/- 6 days. Our data demonstrate that patients with pre-operative RBBB and those receiving CoreValve prosthesis are at a significantly higher risk for PM implantation after TAVI. Therefore, patients with the presence of RBBB before TAVI may be at lower risk for PM implantation using the Edwards Sapiens System.
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. d.erkapic@kerckhoff-klinik.de
authors.forename: Damir
authors.initials: D
authors.lastname: Erkapic
authors.forename: Won K
authors.initials: WK
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Berkowitsch
authors.forename: Sergey
authors.initials: S
authors.lastname: Zaltsberg
authors.forename: Dmitri J
authors.initials: DJ
authors.lastname: Pajitnev
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.forename: Johannes
authors.initials: J
authors.lastname: Sperzel
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Heinz F
authors.initials: HF
authors.lastname: Pitschner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000453:epidemiology* / Q000601:surgery*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005820:Genetic Testing; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D011300:Preoperative Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors