Permanent Pacemaker Implantation Late after Transcatheter Aortic Valve Implantation.

Elchinova, Elena; Nozica, Nikolas; Bartkowiak, Joanna; Ryffel, Christoph; Bernhard, Benedikt; Elsmaan, Mamdouh; Asatryan, Babken; Branca, Mattia; Okuno, Taishi; Lanz, Jonas; Praz, Fabien Daniel; Stortecky, Stefan; Windecker, Stephan; Reichlin, Tobias; Pilgrim, Thomas; Roten, Laurent (2021). Permanent Pacemaker Implantation Late after Transcatheter Aortic Valve Implantation. Heart rhythm, 18(12), pp. 2033-2039. Elsevier 10.1016/j.hrthm.2021.08.010

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BACKGROUND

Impairment of atrioventricular (AV) conduction may occur late after transcatheter aortic valve implantation (TAVI) and progression to complete AV block is a matter of concern.

OBJECTIVE

To describe the incidence of permanent pacemaker (PPM) implantation late after TAVI.

METHODS

In a prospective TAVI registry, we retrospectively identified patients with PPM implantation after hospital discharge for TAVI and analyzed serial ECGs for AV conduction impairment prior to PPM implantation.

RESULTS

Among 1,059 patients discharged after TAVI without PPM between January 2012 and December 2017, 62 patients (5.9%) underwent PPM implantation at a median of 305 days after discharge for TAVI. Indications for PPM implantation late after TAVI were AV conduction impairment in 46 patients (74.2%), sick-sinus-syndrome in 10 (16.1%), cardiac resynchronization or implantable cardioverter/defibrillator indication in two (3.2%), and a pace & ablate strategy in four (6.5%). Clinical symptoms leading to PPM implantation late after TAVI included syncope in 19 patients (30.7%), pre-syncope in seven (11.3%), and dyspnea in eight (12.9%). First-degree AV block and new left bundle branch block (LBBB) after TAVI as well as valve-in-valve procedure during follow-up were independent predictors for PPM implantation late after TAVI due to AV conduction impairment.

CONCLUSIONS

PPM implantation late after TAVI is infrequent and associated with clinical symptoms in half of patients. Impairment of AV-conduction was the indication in three quarters of patients. First-degree AV block and new LBBB after TAVI as well as valve-in-valve procedure during follow-up emerged as independent predictors.

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