title: Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation.
abstract: BACKGROUND
  Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors.
  
  
  METHODS
  We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing.
  
  
  RESULTS
  Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM (P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB (P = .37).
  
  
  CONCLUSIONS
  A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. marcodecarlo@gmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Giulio
authors.initials: G
authors.lastname: Zucchelli
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Jacopo
authors.initials: J
authors.lastname: Oreglia
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D016896:Treatment Outcome