Valvular Heart Disease
Pacemaker Implantation After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2013.07.022Get rights and content

Thirty- to 35% of patients after transcatheter aortic valve implantation undergo implantation of a permanent pacemaker (PPM) because of development of atrioventricular block (AVB) or development of a condition with high risk of progression to AVB. There are insufficient data regarding long-term follow-up on pacing dependency. From February 2009 to July 2011, 191 transcatheter aortic valve implantation procedures were performed at the Rabin Medical Center (125 CoreValve and 66 Edwards SAPIEN). Thirty-two patients (16.7%) received a PPM (30 with CoreValve and 2 with Edwards SAPIEN). Data from the pacemaker clinic follow-up was available in 27 patients. After a mean follow-up of 52 weeks (range, 22 to 103), only 8 (29%) of 27 patients were pacing dependent. The indication of PPM in these 8 patients was complete AVB. In conclusion, in our center, the rate of PPM implantation was 16%, which is lower than that reported in the published works. Only 29% of those patients implanted with PPM were pacemaker dependent. Further studies are necessary to define reliable predictors for long-term pacing.

Section snippets

Methods

From February 2009 to July 2012, 191 patients underwent TAVI, for severe aortic stenosis, at the Rabin Medical Center. The indications for TAVI were according to the European Society of Cardiology guidelines8 and the Heart Team decision. One hundred twenty-five patients were implanted with a CoreValve (CV) (Medtronic Inc., Minneapolis, Minnesota) and 66 with Edwards SAPIEN valve (ES) (Sapien or Sapien XT, Edwards Lifesciences, Irvine LLC, California). Thirty-two of these patients were implanted

Results

Of the 191 patients who underwent TAVI, 32 patients (16.7%) were implanted with a PPM (30 after CV and 2 after ES implantation, respectively). Three patients died (non-PPM–related cause) before the first pacemaker clinic visit (2 after CV and 1 after ES implantation), and 2 patients were lost to follow-up (both with CV). Thus, pacemaker clinic follow-up data were available for 27 patients. To assess long-term pacemaker dependency, we collected data from the latest available visit for each

Discussion

The main finding of this study was that only 29% of the patients, who were implanted with a PPM after TAVI, were pacing dependent at long-term follow-up (mean 52 weeks after PPM implantation). This finding is consistent with that of previous studies. Guetta et al6 reported on 70 patients who underwent TAVI, 28 (40%) of them received a new PPM after the procedure and only 40% were pacing dependent at 3-month follow-up. Van der Boon et al7 reported on 167 patients who underwent TAVI (all with

Disclosures

The authors have no conflicts of interest to disclose.

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