Key result
The use of the Medtronic CoreValve Revalving System was an independent predictor of high-grade AV block after TAVI (OR 79.25; 95% CI 4.57-1373.31).
Why the study?
What are the predictors for permanent pacemaker implantation and the need for ventricular pacing during follow-up after TAVI?
Cohort (n=97)
What are the predictors for permanent pacemaker implantation and the need for ventricular pacing during follow-up after TAVI?
Odds Ratio: 79.25 (95% CI 4.57–1373.31)
Early permanent pacemaker implantation is justified for high-grade AV block after TAVI, but a more conservative approach may be warranted for new-onset LBBB, as these patients did not require ventricular pacing during follow-up.
CoreValve use may heighten post-TAVI AV block vigilance; leaves open device-specific effects on permanent pacing needs.
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. METHOD: 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. CONCLUSION: 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.
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RAMAZZINA et al. (2014) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=97). Medtronic CoreValve Revalving System (MCRS) vs. Edwards-Sapien Valve was evaluated on high-grade AV block (OR 79.25, 95% CI 4.57-1373.31). The use of the Medtronic CoreValve Revalving System was an independent predictor of high-grade AV block after TAVI (OR 79.25; 95% CI 4.57-1373.31).
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