112 Outcomes of pacemaker implantation rates post transcatheter aortic valve implantation from a single U.K tertiary centre

Introduction Atrioventricular conduction disturbance leading to permanent pacemaker (PM) implantation is a frequent and relevant complication after transcatheter aortic valve implantation (TAVI). There is no recognised monitoring period to allow for resolution after the post-TAVI patients have developed conduction disease. We aimed to evaluate the rate of post-TAVI permanent PM implantation over time, and to determine what pacing percentage these patients have at their first and second follow up, as well as to determine whether their pacing need increased, decreased, or stayed the same. Methods A retrospective observational study was performed using data collected from the NICOR database for patients who required pacing devices after TAVI implantation in the period of 2019 to 2021 at a single tertiary TAVI centre. Demographic data including age, gender, ECG pre and post TAVI, pacemaker type and number of days between TAVI and device implant, were evaluated. We analysed their ventricular pacing percentage at their initial follow up and subsequent follow up. Results Of 883 TAVI patients, 52 (median age 81.5±6.8 p =0.24, 54.7% males) underwent pacing implantation after TAVI. The majority of patients pre-TAVI were in sinus rhythm with no statistically significant difference between the rhythms (sinus rhythm-36 (67.9%), AF-14 (26.4%), AV block-2 (3.8%), Paced-1(1.9%) p 0.11). In post-TAVI patients, 62.3% were in AV block (Sinus-17.0%, AF-9.4%, AF with AV block-1.9%, Ventricular standstill-5.7% Paced-1.9%, AV block and ventricular standstill-1.9% p 0.11). The majority of patients pre-TAVI did not have any right or left bundle branch block with no statistically significant difference between the variables (LBBB-9.4%, RBBB-17.0%, None- 73.6%, p 0.28) whereas 34.6% and 15.4% of patients post-TAVI were LBBB and RBBB respectively (p 0.63). Time to pacemaker implantation was 18.4±45.1days. The majority of patient post-TAVI had a dual chamber pacemaker with no statistically significant difference between the device type across all 3 years. Percentage of ventricular pacing at 6-week check was 50±41(p 0.24) and at 12-month check was 44±43 (p 0.61) (figures 1 and 2) Conclusions Conduction disturbances after transcatheter aortic valve implantation (TAVI) are often transient. Our data shows that the risk needing a PPM post TAVI is 3–10%. The average time from TAVI implant to needing a pacemaker is 18 days (p=0.63). There is no significant difference between the ventricular pacing percentage at the 6 weeks versus the 12 months check over the 3 years. Considering the growing population undergoing TAVI, multi-centred study of permanent pacemaker utilisation, risks, and long-term pacing dependency, should be undertaken to develop nationally agreed guidance on indication and timing of pacing in post-TAVI patients. Conflict of Interest No