title: Incidence and predictors of permanent pacemaker requirement after transcatheter aortic valve implantation with a self-expanding bioprosthesis.
abstract: BACKGROUND
  Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single-center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self-expanding bioprosthesis.
  
  
  METHODS
  From August 2007 to October 2009, 32 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV) System (Medtronic Inc., Minneapolis, MN, USA). Three patients paced at baseline and two cases of procedure-related mortality were excluded. We analyzed the 12-lead electrocardiogram at baseline, immediately after procedure and at discharge. Requirements for PPM were documented and potential clinical, electrophysiological, echocardiographic, and procedural predictors of PPM requirement were studied.
  
  
  RESULTS
  After TAVI, eight patients (29.6%) required PPM implantation due to high-grade atrioventricular (AV) block. The prevalence of left bundle branch block increased from 13.8% to 57.7% directly after implantation (P = 0.001). Need for PPM was correlated to the depth of prosthesis implantation (r = 0.590; P = 0.001). At a cutoff point of 10.1 mm, the likelihood of pacemaker could be predicted with 87.5% sensitivity and 74% specificity and a receiver operator characteristic curve area of 0.86 ± 0.07 (P = 0.003). Of the seven patients with preexisting right bundle branch block (RBBB), four (57.1%) required PPM implantation after TAVI.
  
  
  CONCLUSIONS
  High-grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high-grade AV block and subsequent pacemaker implantation.
authors: Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. ferreira.nmd@gmail.com
authors: Nuno Dias
authors: ND
authors: Ferreira
authors: Daniel
authors: D
authors: Caeiro
authors: Luís
authors: L
authors: Adão
authors: Marco
authors: M
authors: Oliveira
authors: Helena
authors: H
authors: Gonçalves
authors: José
authors: J
authors: Ribeiro
authors: Madalena
authors: M
authors: Teixeira
authors: Aníbal
authors: A
authors: Albuquerque
authors: João
authors: J
authors: Primo
authors: Pedro
authors: P
authors: Braga
authors: Lino
authors: L
authors: Simões
authors: Vasco Gama
authors: VG
authors: Ribeiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D054537:Atrioventricular Block / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D001705:Bioprosthesis / Q000009:adverse effects; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014463:Ultrasonography