title: Transcatheter aortic valve implantation and requirements of pacing over time.
abstract: BACKGROUND
  A permanent pacemaker (PPM) implantation is common after transcatheter aortic valve implantation (TAVI). We sought to evaluate requirements of pacing and incidence of pacemaker dependency during the first year after TAVI.
  
  
  METHODS
  From August 2007 until May 2011, 65 patients underwent TAVI with self-expandable prosthesis. Five patients paced at baseline and two procedure-related deaths were excluded. Evaluation of ventricular pacing percentage (VP%) and look for spontaneous rhythm were performed at 3, 6, and 12 months.
  
  
  RESULTS
  PPM implantation was required in 19/58 patients (33%). Mean VP% decreased between assessments (59% at 3 months, 48% at 6 months, 50% at 12 months), but overall VP% at 1 year was high (57% ± 43%) and most patients were paced ≥10% of time. A favorable annulus-to-aorta angle was associated with lower pacing requirements (60% of patients paced ≤10% of time vs 10% of patients paced >10% of time presented an angle ≤30⁰, P = 0.039). Pacemaker dependency was established in 27% of patients and could be predicted by the presence of porcelain aorta (odds ratio = 30, confidence interval 95% 1-638, P = 0.029). New postprocedural left bundle branch block (LBBB) had a negative impact on 1-year survival (58% vs 82% in non-LBBB group, P = 0.111). PPM implantation had no impact on 1-year survival.
  
  
  CONCLUSIONS
  One third of patients required PPM after TAVI and full recovery of advanced conduction abnormalities seems unlikely. Unfavorable aortic root orientation may hinder the deployment of the valve and contribute to the continued impairment of the conduction system. Porcelain aorta was a strong predictor of pacemaker dependency.
authors.affiliation: Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. eulaliaalvespereira@gmail.com
authors.forename: Eulália
authors.initials: E
authors.lastname: Pereira
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.forename: Daniel
authors.initials: D
authors.lastname: Caeiro
authors.forename: João
authors.initials: J
authors.lastname: Primo
authors.forename: Luís
authors.initials: L
authors.lastname: Adão
authors.forename: Marco
authors.initials: M
authors.lastname: Oliveira
authors.forename: Helena
authors.initials: H
authors.lastname: Gonçalves
authors.forename: José
authors.initials: J
authors.lastname: Ribeiro
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Santos
authors.forename: Daniel
authors.initials: D
authors.lastname: Leite
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.forename: Lino
authors.initials: L
authors.lastname: Simões
authors.forename: Luís
authors.initials: L
authors.lastname: Vouga
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome