Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomaterials in Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) is frequently associated with the need for permanent pacemaker implantation.
• Pacing rates after TAVR vary depending on the specific device used, with previous studies reporting rates around 29% for the LOTUS device.

Purpose of the Study:

• To determine the incidence of pacemaker implantation up to hospital discharge following LOTUS bioprosthesis implantation.
• To identify factors influencing pacing rate and the need for pacemaker implantation after LOTUS valve implantation in the United Kingdom.

Main Methods:

• Retrospective data collection from 228 patients who received the LOTUS device between March 2013 and February 2015 across 10 UK centers.
• Exclusion of 27 patients (12%) with pre-existing pacemakers.
• Analysis of patient demographics, pre-procedural electrocardiogram findings, and procedural characteristics to identify predictors of pacemaker implantation.

Main Results:

• 32% of patients (64 out of 201 analyzed) required pacemaker implantation, with a median time to insertion of 3.0 days.
• The primary indications for pacing were atrioventricular (AV) block (72%) or left bundle branch block (LBBB) with first-degree AV block (17%).
• Pre-procedural conduction abnormalities (OR: 2.54; p=0.048) and absence of aortic valve calcification (OR: 0.55; p=0.031) were independently associated with increased pacing need.

Conclusions:

• Following LOTUS valve implantation, 55% of patients developed LBBB and 32% required a pacemaker during the index admission.
• Patients with pre-procedural conduction disturbances and non-calcified aortic valves demonstrated a higher likelihood of requiring pacing.
• No other anatomical features were identified as increasing the pacing requirement for the LOTUS device.