Pot-pourri
Incidence of permanent pacemaker implantation after TAVI and re-evaluation of the indications after the periprocedural period
Aims: Transcatheter aortic valve implantation (TAVI) has evolved to be an efficient treatment for surgical extreme and high-risk patients with aortic stenosis. However, using the CoreValve (CV) system carries a risk of atrioventricular (AV) conduction system abnormalities requiring permanent pacemaker (PPM) implantation (PPMI) in up to 30% of the patients. The aims of the study were to examine the incidence of PPMI after TAVI using the CV system at the Rigshospitalet and evaluate the patients’ indication for PPM after the periprocedural period.
Methods and results: Data were analysed for the first 258 consecutive patients (149 males [58%] mean age 80.3±7 years) who underwent TAVI at Rigshospitalet University Hospital of Copenhagen. The indications for PPM were divided into periprocedural or not (≤30 days or >30 days), as well as TAVI-related indications and non-TAVI-related indications (AV block or not). In addition, the TAVI-related indications were divided into absolute indications (3rd degree AV block and 2nd degree AV block type II and advanced) and relative indication for PPM (2nd degree AV block type I and 1st degree AV block with left bundle branch block). Patients who received a PPM were re-evaluated for the indication >30 days after their TAVI procedure. Twenty-four (9%) of the patients who underwent TAVI were excluded from the study due to PPM or indication for PPM prior to TAVI. Seventy-five (32%) of the patients received a PPM after TAVI; 63 (26.9%) patients within 30 days after TAVI and 12 (5%) patients after 30 days. Of the 63 patients who received a new PPM <30 days, 53 (84%) had a TAVI-related indication, and 46 of these patients (88%) had an absolute indication. However, at the F/U only 50% still had an absolute indication for PPM, whereas the 3rd degree AV block or the 2nd degree AV block type II or advanced was resolved in the rest of the patients.
Conclusions: Our data confirm that the incidence of PPM after TAVI is high (26.9%), but only 19.7% received a PPM on an absolute indication within 30 days after the procedure. Furthermore, after the periprocedural period, only 9.8% of the TAVI patients without a pre-existing device had an absolute indication for PPM. This suggests that the PPMI may be reduced by postponing the decision to ≥10 days after TAVI, as is the practice after surgical aortic valve replacement.
