title: Complete atrioventricular block after TAVI: when is pacemaker implantation safe?
abstract: BACKGROUND
  Atrioventricular (AV) block is a frequent complication of transcatheter aortic valve implantation (TAVI). TAVI is routinely performed under anticoagulation using heparin, which potentially may lead to an increased bleeding rate in patients who undergo permanent pacemaker (PPM) implantation immediately after TAVI. As the number of TAVI procedures continues to rise, data on the optimal management of TAVI-related AV block are needed. Therefore, the aim of our study was to analyze PPM implantation-related complications after TAVI.
  
  
  METHODS
  We retrospectively collected data on PPM implantations after TAVI in our center from January 2010 to December 2012. In total, we included 30 patients who received a PPM for TAVI-related AV block. Twelve patients (group A) underwent PPM implantation on the day of TAVI. In 18 patients (group B), PPM implantation was performed at least 1 day after TAVI (3.8 ± 4.5 days). Since all patients undergoing TAVI receive dual antiplatelet therapy (DA-therapy), we compared all implantations after TAVI with a historic patient cohort that underwent PPM implantation under DA-therapy.
  
  
  RESULTS
  Procedure times, fluid loss via drainage systems, and drainage times were neither significantly different between groups A and B nor between all PPM implantations after TAVI compared to the historic control group.
  
  
  CONCLUSIONS
  PPM implantation immediately after TAVI is safe and can be performed without increased rate of complications.
authors.affiliation: Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Germany. marius.schwerg@charite.de
authors.forename: Marius
authors.initials: M
authors.lastname: Schwerg
authors.forename: Gerd
authors.initials: G
authors.lastname: Baldenhofer
authors.forename: Henryk
authors.initials: H
authors.lastname: Dreger
authors.forename: Hansjürgen
authors.initials: H
authors.lastname: Bondke
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: Christoph
authors.initials: C
authors.lastname: Melzer
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000601:surgery*; D054537:Atrioventricular Block / Q000453:epidemiology* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: TAVI; anticoagulation; antiplatelet therapy; pacemaker