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Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing

M Z Khawaja1, R Rajani, A Cook

  • 1UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.

Circulation
|February 23, 2011
PubMed

Insights

A significant one-third of patients need a permanent pacemaker (PPM) after CoreValve transcatheter aortic valve implantation. Factors like heart block and balloon predilatation increase this risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Permanent pacemaker (PPM) requirement is a known complication following transcatheter aortic valve implantation (TAVI).
  • Assessing the incidence and predictors of PPM post-CoreValve TAVI is crucial for patient management.

Purpose of the Study:

  • To determine the incidence of PPM within 30 days of CoreValve implantation in the UK.
  • To develop an anatomic and electrophysiological model predicting PPM need after TAVI.

Main Methods:

  • Retrospective analysis of 270 patients undergoing CoreValve TAVI across 10 UK centers.
  • Evaluation of baseline and post-procedure ECG parameters, including QRS duration and bundle branch block incidence.
  • Multivariable analysis to identify independent predictors of PPM requirement.

Main Results:

  • 33.3% of patients required a PPM within 30 days post-procedure.
  • Significant increases in QRS duration (105 to 135 ms) and LBBB incidence (13% to 61%) were observed.
  • Independent predictors for PPM included periprocedural AV block, balloon predilatation, larger prosthesis size, increased septal diameter, and prolonged QRS duration.

Conclusions:

  • One-third of patients undergoing CoreValve TAVI require a PPM within 30 days.
  • Periprocedural AV block, balloon predilatation, larger prosthesis, increased interventricular septum diameter, and prolonged QRS duration are associated with PPM need.
Abstract

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