title: Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative).
abstract: BACKGROUND
  Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model.
  
  
  RESULTS
  Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM.
  
  
  CONCLUSIONS
  One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
authors.affiliation: UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Khawaja
authors.forename: R
authors.initials: R
authors.lastname: Rajani
authors.forename: A
authors.initials: A
authors.lastname: Cook
authors.forename: A
authors.initials: A
authors.lastname: Khavandi
authors.forename: A
authors.initials: A
authors.lastname: Moynagh
authors.forename: S
authors.initials: S
authors.lastname: Chowdhary
authors.forename: M S
authors.initials: MS
authors.lastname: Spence
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.forename: S Q
authors.initials: SQ
authors.lastname: Khan
authors.forename: N
authors.initials: N
authors.lastname: Walker
authors.forename: U
authors.initials: U
authors.lastname: Trivedi
authors.forename: N
authors.initials: N
authors.lastname: Hutchinson
authors.forename: A J
authors.initials: AJ
authors.lastname: De Belder
authors.forename: N
authors.initials: N
authors.lastname: Moat
authors.forename: D J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: R D
authors.initials: RD
authors.lastname: Levy
authors.forename: G
authors.initials: G
authors.lastname: Manoharan
authors.forename: D
authors.initials: D
authors.lastname: Roberts
authors.forename: S S
authors.initials: SS
authors.lastname: Khogali
authors.forename: P
authors.initials: P
authors.lastname: Crean
authors.forename: S J
authors.initials: SJ
authors.lastname: Brecker
authors.forename: A
authors.initials: A
authors.lastname: Baumbach
authors.forename: M
authors.initials: M
authors.lastname: Mullen
authors.forename: J-C
authors.initials: JC
authors.lastname: Laborde
authors.forename: D
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000379:methods / Q000639:trends*; D002304:Cardiac Pacing, Artificial / Q000379:methods / Q000639:trends*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000639:trends*; D012189:Retrospective Studies; D006113:United Kingdom