title: Update on the need for a permanent pacemaker after transcatheter aortic valve implantation using the CoreValve® Accutrak™ system.
abstract: OBJECTIVE
  High rates of permanent pacemaker (PPM) implantation are reported after transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve® system. The Accutrak™ catheter is designed to allow a more predictable landing zone. Little is known about the real clinical impact of this catheter. The aims of this paper were to describe the potential impact of the Accutrak™ catheter on the accuracy of positioning a 26 or 29 mm CoreValve® across the aortic annulus and its impact on the need for a pacemaker.
  
  
  RESULTS
  A total of 134 patients were treated with the CoreValve® Accutrak™ system at two French centres (Lille and Toulouse). Mean age was 82.4 ± 4.7 years; logistic EuroSCORE was 24.3 ± 9.5%. Procedural success rate was 99.2%; mean depth of implantation was 4.9 mm. A final position between 0 and 6 mm was achieved in 85.8% of the patients. All-cause mortality at 30 days was 6%. The PPM implantation rate was 10.6%. Due to a limited number of events, we could not identify any predictor of need for a PPM: pre-existing right bundle branch block (RBBB) (OR 2.72 [0.63-11.87], p=ns), use of a 29 mm prosthesis (OR 2.73 [0.33-22.90], p=ns) and left ventricular septal hypertrophy (OR 2.63 [0.08-83.32], p=ns).
  
  
  CONCLUSIONS
  In this cohort of patients treated with the CoreValve® Accutrak™ system, the incidence of permanent pacemaker implantation was low, which may be a consequence of an average small implantation depth. The Accutrak™ catheter seems to be helpful in achieving higher and more predictable implants. Operators could standardise their technique to place the CoreValve® prostheses less than 6 mm below the aortic annulus.
authors.affiliation: Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France. d.tchetche@clinique-pasteur.com
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.forename: Bruno
authors.initials: B
authors.lastname: Farah
authors.forename: Olivier
authors.initials: O
authors.lastname: Vahdat
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sudre
authors.forename: Mohamad
authors.initials: M
authors.lastname: Koussa
authors.forename: Corinne
authors.initials: C
authors.lastname: Lereun
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nejjari
authors.forename: Michael
authors.initials: M
authors.lastname: Choby
authors.forename: Julien
authors.initials: J
authors.lastname: Rosencher
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D057785:Catheters; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D016896:Treatment Outcome