title: Need for permanent pacemaker as a complication of transcatheter aortic valve implantation and surgical aortic valve replacement in elderly patients with severe aortic stenosis and similar baseline electrocardiographic findings.
abstract: OBJECTIVE
  The aim of this study was to compare the incidence and predictive factors of complete atrioventricular block (AVB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).
  
  
  BACKGROUND
  No data exist on the need for PPI after TAVI versus SAVR in patients with similar baseline electrocardiographic (ECG) findings.
  
  
  METHODS
  A total of 411 patients with severe aortic stenosis (AS) and no prior pacemaker who underwent TAVI with the balloon-expandable Edwards valve (Edwards Lifesciences, Irvine, California) were matched (1:1) with 411 elderly patients with severe AS who underwent isolated SAVR on the basis of baseline ECG findings. The incidence, reasons, and predictive factors for PPI within 30 days after the procedure were compared between groups.
  
  
  RESULTS
  Mean age was similar in both groups (p = 0.11), and the TAVI group had a higher Society of Thoracic Surgeons score (p < 0.001). The rate of new PPI was higher after TAVI (7.3%) compared with SAVR (3.4%), p = 0.014. Complete AVB and severe symptomatic bradycardia, respectively, were the reasons for PPI in the TAVI (5.6% and 1.7%, respectively) and SAVR (2.7% and 0.7%, respectively) groups (p = 0.039 for complete AVB, p = NS for symptomatic bradycardia). The presence of baseline right bundle branch block was the only variable associated with PPI in the TAVI group (odds ratio: 8.61, 95% confidence interval: 3.14 to 23.67, p < 0.0001), whereas no variable was found in the SAVR group.
  
  
  CONCLUSIONS
  Transcatheter aortic valve implantation was associated with a higher rate of complete AVB and PPI compared with SAVR in elderly patients with severe AS and similar baseline ECG findings. The presence of baseline right bundle branch block correlated with the need for PPI in the TAVI group.
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
authors.affiliation: Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Manazzoni
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.affiliation: Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Bainey
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002170:Canada; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002304:Cardiac Pacing, Artificial; D057785:Catheters; D016009:Chi-Square Distribution; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D057216:Propensity Score; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome