title: Pacemaker implantation and need for ventricular pacing during follow-up after transcatheter aortic valve implantation.
abstract: BACKGROUND
  To categorize indications of permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI), to determine predictors for conduction disturbances and to quantify the need for ventricular pacing during follow-up.
  
  
  METHODS
  We studied 97 patients (median age 83 years, 58% female) undergoing TAVI using the Medtronic CoreValve Revalving System (MCRS; Medtronic Inc., Minneapolis, MN, USA) or Edwards-Sapien Valve (Edwards Lifesciences, Irvine, CA, USA). During follow-up, no need for ventricular pacing was defined as <1% ventricular pacing and intrinsic 1:1 atrioventricular (AV) conduction.
  
  
  RESULTS
  In the 35 patients (36.1%) undergoing PPM implantation three indication categories were identified: (1) high-grade AV block (Mobitz 2 or higher), (2) new-onset left bundle branch block (LBBB) with a prolonged PR interval, and (3) new-onset LBBB. The only independent predictors of high-grade AV block were the use of MCRS (odds ratio [OR] 79.25; 95% confidence interval [CI] 4.57-1373.31) and the presence of preprocedural right bundle branch block (OR 81.95; 95% 95% CI 8.72-770.46). Whereas high-grade AV block resolved only in 17% of cases, none of the patients receiving a PPM due to LBBB with or without PR prolongation required ventricular pacing during follow-up.
  
  
  CONCLUSIONS
  Our findings justify early PPM implantation in patients with high-grade AV block and may suggest a more conservative approach to PPM implantation in patients with new-onset LBBB after TAVI.
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Carola
authors.initials: C
authors.lastname: Ramazzina
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Beat
authors.initials: B
authors.lastname: Schaer
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000628:therapy*; D002037:Bundle-Branch Block / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement
keywords: TAVI; electrophysiology - clinical; pacing