Does TAVI with a CoreValve prosthesis compared to an Edwards-Sapiens prosthesis increase the risk of permanent pacemaker requirement in patients without a prior pacemaker?
TAVI with a CoreValve prosthesis is associated with a nearly 5-fold higher risk of requiring a permanent pacemaker compared to an Edwards-Sapiens prosthesis, with pre-existing RBBB further increasing this risk.
BACKGROUND: Permanent pacemaker (PM) requirement is a known complication after transcatheter aortic valve implantation (TAVI). There are, however, no systematic data concerning this complication. OBJECTIVE: To determine the incidence and potential predictors of permanent PM requirement after TAVI based on published literature. METHODS: We conducted a MEDLINE search to identify potentially relevant literature dealing with PM requirement after TAVI. Data were collected on paper extraction forms by 2 independent investigators. RESULTS: There were 32 relevant published studies comprising data of 5,258 patients without an implanted PM before TAVI. An Edwards-Sapiens® prosthesis (ESP) was implanted in 2,887 patients, whereas 2,371 patients received a CoreValve® prosthesis (CVP). The crude incidence of PM implantation after TAVI was 15%. Six hundred and fourteen of 2,371 (25.8%) CVP patients and 189 of the 2,887 (6.5%) ESP patients had to receive a permanent PM (odds ratio OR 4.91, 95% confidence interval CI 4.12-5.86, P 90% within the first week after the procedure, careful monitoring should be performed for at least 7 days after TAVI.
Erkapic et al. (Thu,) studied this question.