Pacemaker implantation after TAVI: predictors of AV block persistence

• Published in: Clinical research in cardiology Vol. 107; no. 1; pp. 60 - 69
• Main Authors: Gaede, Luise, Kim, Won-Keun, Liebetrau, Christoph, Dörr, Oliver, Sperzel, Johannes, Blumenstein, Johannes, Berkowitsch, Alexander, Walther, Thomas, Hamm, Christian, Elsässer, Albrecht, Nef, Holger, Möllmann, Helge
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2018; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aortic valve; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Atrioventricular Block - diagnosis; Atrioventricular Block - etiology; Atrioventricular Block - physiopathology; Atrioventricular Block - surgery; Cardiac arrhythmia; Cardiac Pacing, Artificial - adverse effects; Cardiology; Electrocardiography; Female; Germany; Heart; Humans; Implantation; Indication; Male; Medicine; Medicine & Public Health; Multivariate Analysis; Odds Ratio; Original Paper; Pacemaker, Artificial; Patients; Predictive Value of Tests; Proportional Hazards Models; Prostheses; Risk Factors; Thorax; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; AVBIII; PPM; Pacemaker; AV block; TAVR; TAVI
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-017-1158-2

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° (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.