Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System

Abstract

Background/objectives: To determine pacemaker (PM) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).

Methods: Single center prospective observational study including 167 patients without previous PM implantation who underwent TAVI with the self-expanding Medtronic CoreValve System (MCS) between November 2005 and February 2011. PM dependency was defined by the presence of a high degree atrioventricular block (HDAVB; second [AV2] and third degree [AV3B]), or a slow (<30 bpm) or absent ventricular escape rhythm during follow-up PM interrogation.

Results: A total of 36 patients (21.6%) received a new PM following TAVI. The indication for PM was AV2B (n=2, 5.6%), AV3B (n=28, 77.8%), postoperative symptomatic bradycardia (n=3, 8.3%), brady-tachy syndrome (n=1, 2.8%), atrial fibrilation with slow response (n=1, 2.8%) and left bundle branch block (n=1, 2.8%). Long term follow-up was complete for all patients and ranged from 1 to 40 months (median (IQR): 11.5 (5.0-18.0 months). Of those patients with a HDAVB, 16 out of the 30 patients (53.3%) were PM independent at follow-up visit (complete or partial resolution of the AV conduction abnormality). Overall, 20 out of the 36 patients (55.6%) who received a new PM following TAVI were PM independent at follow-up.

Conclusion: Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients.

Keywords: AV; AV2B; AV3B; Dependency; Follow-up; HDAVB; LBBB; MCS; Medtronic CoreValve System; PM; PPI; Permanent pacemaker implantation; TAVI; Transcatheter aortic valve implantation; atrioventricular; high degree atrioventricular block (AV2B or AV3B); left bundle branch block; pacemaker; permanent pacemaker implantation; second degree atrioventricular block Mobitz II; third degree atrioventricular block; transcatheter aortic valve implantation.