Reevaluation of the indications for permanent pacemaker implantation after transcatheter aortic valve implantation.
OBJECTIVE
Conduction abnormalities (CA) requiring permanent pacemaker (PPM) are a well-known complication after transcatheter aortic valve implantation (TAVI). This study aimed to determine the incidence of TAVI-related PPM and reevaluate the indications for PPM after the periprocedural period.


RESULTS
A total of 258 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV), whereas 24 patients were excluded from the study. TAVI-related PPM was defined as PPM implantation ≤30 days after the procedure and due to atrioventricular block (AVB). Third-degree AVB, second-degree type-II, or advanced second-degree AVB were considered as absolute indications for PPM. The incidence of TAVI-related PPM implantation was 27.4%. Forty-six patients (19.7%) had an absolute indication for PPM, but CA had resolved in 50% beyond the periprocedural period. Electrocardiographic analysis of the patients who did not have a TAVI-related PPM implantation showed that the PR and QRS intervals increased following TAVI, reaching a peak on days 4-6 and 7-9, respectively, before decreasing to near baseline levels.


CONCLUSIONS
Although the incidence of periprocedural PPM implantation following TAVI was high, most CAs following TAVI tend to resolve after the periprocedural period. This suggests that delaying the decision for PPM implantation after TAVI may reduce the PPM rate.
Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Denmark. j.bjerre.thygesen@gmail.com.
Julie
J
Bjerre Thygesen
Poay Huan
PH
Loh
Jiranut
J
Cholteesupachai
Olaf
O
Franzen
Lars
L
Søndergaard
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D054537:Atrioventricular Block / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003718:Denmark; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index