title: Incidence rate and predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis.
abstract: BACKGROUND
  Conduction disorders and permanent pacemaker (PPM) implantation are common complications in patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies, evaluating small populations, have identified several different predictors of PPM implantation after TAVI. The aim of this study was to assess the incidence rate of conduction disorders and the predictors of postoperative PPM requirement in a large series of patients undergoing TAVI.
  
  
  METHODS
  Data were analyzed from 181 consecutive patients at high-risk surgery who underwent TAVI at our institute between July 2007 and April 2011. All patients underwent implantation of the third-generation percutaneous self-expanding CoreValve® prosthesis (CoreValve, Inc., Irvine, CA, USA). In all patients, a 12-lead electrocardiogram and a 24-h holter monitoring was recorded before and after the procedure in order to assess the presence of conduction disorders. Clinical data, preoperative conduction disorders, echocardiographic patterns, and procedural data were tested as predictors of PPM implantation after TAVI.
  
  
  RESULTS
  Left bundle branch block (LBBB) was the most common conduction disorder, with an incidence of 50.3% at discharge. Fifty-two (32.1%) patients developed a persistent complete AVB requiring PPM implantation. PPM implantation was strongly correlated with the presence of preoperative right bundle branch block (RBBB) which was found to be the only independent predictor of PPM implantation (HR 16.5, CI 3.3-82.3, p < 0.001).
  
  
  CONCLUSIONS
  LBBB and PPM implantation requirement after TAVI are common occurrences using the self-expanding CoreValve prosthesis. In this large series of consecutive patients, only RBBB was found to be a strong predictor of PPM requirement.
authors: Cardiology Department, Ferrarotto Hospital, University of Catania, via Citelli 1, Catania, 95100, Sicily, Italy.
authors: Valeria
authors: V
authors: Calvi
authors: Sergio
authors: S
authors: Conti
authors: Giusi Paola
authors: GP
authors: Pruiti
authors: Davide
authors: D
authors: Capodanno
authors: Euglena
authors: E
authors: Puzzangara
authors: Donatella
authors: D
authors: Tempio
authors: Angelo
authors: A
authors: Di Grazia
authors: Gian Paolo
authors: GP
authors: Ussia
authors: Corrado
authors: C
authors: Tamburino
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000401:mortality*; D011474:Prosthesis Design; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate