title: Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Pacemaker (PM) implantation is a possible requirement after transcatheter aortic valve implantation (TAVI). The study aim was to evaluate the electrocardiographic and imaging predictors of the need for PM implantation after TAVI.
  
  
  METHODS
  A total of 80 consecutive patients (mean age 82 +/- 6 years) who had been referred for TAVI were included in the study. Transfemoral TAVI was performed in 58 patients (CoreValve ReValving; 72%), while 22 patients (28%) underwent transapical TAVI using the Edwards SAPIEN valve. Patient characteristics, and the frequency of atrioventricular (AV) block, right bundle branch block (RBBB) and left bundle branch block (LBBB), were evaluated for the prediction of PM implantation after TAVI. In addition, the severity and distribution of aortic valve calcification (AVC) were assessed by calculating the Agatston AVC score for the total aortic valve, as well as for each cusp, using dual-source computed tomography.
  
  
  RESULTS
  Pre-procedural RBBB was present in six patients (8%), while eight patients (10%) showed pre-procedural LBBB. In 20 of the 80 patients (25%), a new LBBB was observed after TAVI. In 17 TAVI patients (21%; only CoreValve patients) there was an indication for permanent PM implantation that was related to complete AV block (n = 13) or complete RBBB or LBBB with AV delay (n = 4). Four of six patients (67%) with pre-procedural RBBB received a PM after TAVI. Multivariate logistic regression analysis revealed that only prosthesis type (r = 0.30, p = 0.01) and pre-procedural RBBB (r = 0.4, p = 0.02) were significantly associated with the need for permanent PM implantation after TAVI.
  
  
  CONCLUSIONS
  TAVI is frequently associated with new conduction disturbances. A higher incidence of new LBBB and of permanent PM requirement occurred with the CoreValve ReValving system. There was no relationship between the severity or distribution of AVC and the need for PM implantation after TAVI. Patients with pre-procedural RBBB are deemed to be at risk for PM implantation after TAVI.
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, RWTH University Aachen, Aachen, Germany. rkoos@ukaachen.de
authors.forename: Ralf
authors.initials: R
authors.lastname: Koos
authors.forename: Andreas Horst
authors.initials: AH
authors.lastname: Mahnken
authors.forename: Omer
authors.initials: O
authors.lastname: Aktug
authors.forename: Guido
authors.initials: G
authors.lastname: Dohmen
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed