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Permanent pacemaker implantation after TAVI: clinical features and percentage of ventricular pacing
Background: Transcatheter aortic valve implantation (TAVI) has become a less invasive technique for the treatment of severe aortic stenosis in high surgical risk patients. Postprocedural permament pacemaker (PPM) implantation due to bradyarrhythmias is frequently observed. The purpose of this research is to describe the clinical features and the percentage of ventricular pacing in patients with postprocedural permament pacemaker implantation. Methods: Descriptive study of patients in whom TAVI was performed and required postprocedural permament pacemaker implantatio between January 2014 and Januray 2017, to determine epidemiological characteristics, prevalence of cardiovascular risks factors and percentage of ventricular pacing at the first follow-up 2-3 months after TAVI. Results: 31 patients (48.4% males) in whom TAVI was performed required postprocedural permament pacemaker implantation, the mean age was 78.4?±?6.6 years. Before the procedure 26 patients were in sinus rhythm (SR), 1 had 1st degree atrioventricular block (AVB), the remaining were in atrial fibrillation (AF). Intraventriuclar conduction abnormalities (IVCA) were present in 8 patients (2 with RBBB, 2 with LBBB, 1 with LAFB and 3 with RBBB+LAFB). The prevalence of hypertension, DM and chronic kidney disease were 80.6%, 32.3% and 19.4%, respectively. The mean LVEF value measured by transthoracic echocardiography was 59±12.8%. In 22 patients the TAVI was transfemoral, 3 subclavian and 6 transapical. The indications for PPM were persistent complete AVB in 19 patients (61.3%), Mobitz type II AVB in 3 patients (9.7%), new onset LBBB associated with 1° degree AVB in 7 patients (22.6%), asystole in 1 patient (3.2%) and severe symptomatic sinus bradycardia (SSSB) in 1 patient (3.2%). The average percentage of ventricular pacing at the first follow-up 2-3 months after TAVI were 58.7±41.4%. PM-dependency (intrinsic rhythm <?30 bpm) occurred in 14 patients (45.16?%). Patients in whom the baseline ECG showed no impairment of intraventricular conduction had lower percentage of ventricular pacing (SR without IVCA 59±12.8%, AF without IVCA 29±35%, RBBB 97±2.8%, LBBB 67±45%, RBBB+LAFB 81.3±28.1%). Patient in whom the indication for PPM were advanced/complete AVB or asystole presented a higher percentage of ventricular pacing (complete AVB 65.2±40.6%, Mobitz type II AVB 70.6±50.8%, asystole 100%, LBBB+1°degree AVB 29.5±36.1%, SSSB 62%). Conclusion: The patients in whom TAVI is performed are at risk of new-onset conduction abnormalities. The need for PPM is linked to the preexistence of IVCA, while patients without preexistence of IVCA have lower prevalence of PM-dependency, as well as lower percentage of ventricular pacing.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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