Pacemaker memory in post-TAVI patients: Who should benefit from permanent pacemaker implantation?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
• Atrioventricular (AV) conduction disorders are frequent complications post-TAVI, often necessitating permanent pacemaker implantation (PPI).
• Understanding ventricular pacing (VP) rates after TAVI is crucial for managing these conduction disorders.

Purpose of the Study:

• To quantify the rate of ventricular pacing (VP) in patients who received permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).
• To analyze VP rates based on the specific indications for PPI post-TAVI.

Main Methods:

• A retrospective analysis of patients who underwent PPI after TAVI at Rouen University Hospital from October 2009 to January 2017.
• Indications for PPI included complete atrioventricular block (CAVB) or 2:1 AV block, and new-onset persistent left bundle branch block (NOP-LBBB) with specific PR or HV intervals.
• The primary endpoint was the percentage of VP at the first pacemaker interrogation.

Main Results:

• Out of 936 TAVI patients, 87 (9.3%) received PPI; 80 were analyzed.
• A significant VP percentage (≥1%) was observed in 75% of analyzed patients at first interrogation.
• Patients with CAVB had a 90.2% VP rate, while those with NOP-LBBB had a 52.2% VP rate.

Conclusions:

• Permanent pacemaker implantation (PPI) is supported in TAVI patients with complete atrioventricular block (CAVB), even if paroxysmal.
• Consideration for PPI is suggested in TAVI patients with new-onset persistent left bundle branch block (NOP-LBBB) and prolonged PR or HV intervals.
• No clinical factors predicted significant VP percentage post-TAVI.