What question did this study set out to answer?

To evaluate the incidence and clinical, procedural, and electrophysiological determinants of cardiac conduction disorders and permanent pacemaker requirement after transcatheter aortic valve implantation.

August 17, 2010Pacing and Clinical Electrophysiology

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self-Expanding Bioprosthesis

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Why the study?

What is the incidence and what are the predictors of permanent pacemaker requirement after TAVI with a self-expanding bioprosthesis?

Key Points

To evaluate the incidence and clinical, procedural, and electrophysiological determinants of cardiac conduction disorders and permanent pacemaker requirement after transcatheter aortic valve implantation.
Analyzed consecutive patients undergoing transcatheter aortic valve implantation with the Medtronic CoreValve system (N=32 initial, with 3 baseline-paced and 2 procedural mortality cases excluded, leaving N=27 analyzed).
Recorded 12-lead electrocardiograms at baseline, immediately post-procedure, and at discharge to evaluate conduction abnormalities alongside echocardiographic and procedural factors.
Permanent pacemaker implantation was required in 29.6% (8/27) of patients due to high-grade atrioventricular block, while left bundle branch block prevalence rose from 13.8% to 57.7% post-procedure (P = 0.001).
Pacemaker requirement correlated with depth of prosthesis implantation (r = 0.590; P = 0.001), where a depth cutoff of 10.1 mm predicted pacemaker need with 87.5% sensitivity, 74% specificity, and an AUC of 0.86 ± 0.07 (P = 0.003).
Preexisting right bundle branch block was associated with post-procedural pacing, occurring in 57.1% (4/7) of affected patients.

Structured PICO

What is the incidence and what are the predictors of permanent pacemaker requirement after TAVI with a self-expanding bioprosthesis?

Population

27 analyzed patients (from an initial 32 consecutive patients) undergoing transcatheter aortic valve implantation (TAVI) with a self-expanding bioprosthesis, excluding those paced at baseline or with procedure-related mortality.

Intervention

Transcatheter aortic valve implantation (TAVI) with a self-expanding bioprosthesis (Medtronic CoreValve System)

Outcome

Incidence of postprocedural conduction disorders, need for permanent pacemaker (PPM), and its determinantssafety

Permanent pacemaker requirement is a common complication after TAVI with a self-expanding bioprosthesis, strongly predicted by deeper prosthesis implantation and preexisting right bundle branch block.

Discussion

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Implication

Greater implantation depth was associated with PPM need after TAVI; leaves open optimal thresholds for prospective validation.

Cite This Study

Ferreira et al. (2010) studied this question.

synapsesocial.com/papers/6a87f0c42600694f974de64f https://doi.org/10.1111/j.1540-8159.2010.02870.x

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Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self-Expanding Bioprosthesis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self-Expanding Bioprosthesis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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