Journal article

Publication year: 2018

Pages: 60-69

Journal: Clinical Research in Cardiology

Volume number: 107

Issue number: 1

ISSN: 1861-0684

eISSN: 1861-0692

DOI Link: https://doi.org/10.1007/s00392-017-1158-2

Publisher: Springer

Abstract: 

Aims Approximately every fifth patient undergoing transcatheter aortic valve implantation (TAVI) requires a permanent pacemaker (PPM) after the procedure. The aim of this study was to analyse predictors of atrioventricular block III degrees (AVBIII) persistence with concurrent PPM dependency after TAVI.

Methods and results Between 2010 and 2015 a total of 1198 patients underwent TAVI at the Kerckhoff Heart and Thorax Center, Germany. After exclusion of patients with prior PPM (n = 173) 14.7% (n = 176) of the patients underwent PPM implantation after the procedure. Independent predictors of PPM implantation were pre-existing right bundle branch block (RBBB, p < 0.001) and implantation of a CoreValve prosthesis (p < 0.001). A subgroup of patients with a newly implanted PPM (n = 102) were followed-up for a median of 73 (IQR 62-85) days. The leading indication for PPM implantation was AVBIII in 74.5% (76/102). Of these patients only 22.4% (17/76) had persistent AVBIII at follow-up. Predictors of AVBIII persistence were prior RBBB (p = 0.04), postdilatation (p = 0.006) and higher mean aortic valve gradient prior to implantation (p = 0.013). PPMs were implanted earlier in patients with persisting AVBIII [1 day (IQR0-2.5) vs. 4 days (IQR2-7); p < 0.001]. Early PPM implantation after TAVI was the only independent predictor of persistent AVBIII [OR 1.36 (95% 1.05-1.75); p = 0.02].

Conclusion The long-term persistence of AVBIII is generally low after TAVI. Therefore, it may be wise to postpone the indication for PPM implantation for a couple of days. The only predictors of a lack of recovery of the AVB are prior RBBB, higher mean aortic valve gradients and postdilatation of the prosthesis.

Harvard Citation style: Gaede, L., Kim, W., Liebetrau, C., Doerr, O., Sperzel, J., Blumenstein, J., et al. (2018) Pacemaker implantation after TAVI: predictors of AV block persistence, Clinical Research in Cardiology, 107(1), pp. 60-69. https://doi.org/10.1007/s00392-017-1158-2

APA Citation style: Gaede, L., Kim, W., Liebetrau, C., Doerr, O., Sperzel, J., Blumenstein, J., Berkowitsch, A., Walther, T., Hamm, C., Elsaesser, A., Nef, H., & Moellmann, H. (2018). Pacemaker implantation after TAVI: predictors of AV block persistence. Clinical Research in Cardiology. 107(1), 60-69. https://doi.org/10.1007/s00392-017-1158-2