Short-term pacemaker dependency after transcatheter aortic valve implantation.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for severe aortic stenosis in high-risk patients.
• Conduction disturbances necessitating permanent pacemaker (PPM) implantation are common post-TAVI.

Purpose of the Study:

• To determine the incidence of high-grade atrioventricular (AV) block after TAVI.
• To assess the rates of ventricular pacing and pacemaker dependency at 6-8 weeks post-TAVI.

Main Methods:

• Retrospective analysis of 153 patients undergoing TAVI for severe aortic stenosis.
• Evaluation of PPM implantation rates, reasons for pacing, and pacemaker dependency.
• Analysis of pacing parameters and patient rhythm at follow-up.

Main Results:

• A PPM was implanted in 31% of patients (20%), with variations based on valve type (Medtronic CoreValve vs. Edwards Sapien).
• Complete AV block was the primary indication for PPM (68%), particularly in patients with pre-existing bundle branch block.
• At follow-up, 37% of patients were pacemaker-dependent, while 57% exhibited an intrinsic rhythm >50 bpm.

Conclusions:

• The PPM implantation rate of 20% post-TAVI aligns with existing literature.
• PPM necessity is influenced by TAVI valve type and pre-existing right bundle branch block.
• The significant proportion of patients with recovered intrinsic rhythm suggests that temporary conduction disturbances may resolve, potentially supporting a conservative management approach.