Pacemaker Implantation for Low-Grade Conduction Abnormalities After Balloon-Expandable Transcatheter Aortic Valve...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Post-procedural conduction abnormalities are a frequent complication of transcatheter aortic valve implantation (TAVI).
• Permanent pacemaker (PM) implantation is often required for these abnormalities.
• The necessity of PM implantation for borderline conduction abnormalities after TAVI warrants further investigation.

Purpose of the Study:

• To analyze the characteristics of borderline conduction abnormalities after TAVI that led to PM implantation.
• To evaluate the ventricular pacing amounts in patients with borderline conduction abnormalities post-TAVI.

Main Methods:

• Retrospective analysis of 1083 patients who underwent balloon-expandable TAVI between 2014 and 2019.
• Identification of patients who developed postinterventional conduction abnormalities requiring PM implantation.
• Analysis of patient characteristics, conduction abnormalities, and ventricular pacing percentages at 24 hours and 6 weeks.

Main Results:

• 165 out of 1083 TAVI patients (15.2%) developed conduction abnormalities requiring PM implantation.
• 19 of these patients (11.5%) had borderline conduction abnormalities not clearly indicated for pacing per guidelines.
• Most patients with borderline abnormalities showed low or no ventricular pacing at 24 hours and 6 weeks, with decreasing trends over time.

Conclusions:

• A significant proportion of PM implantations after TAVI may be for borderline conduction abnormalities.
• The risk of complete persisting heart block is low in these patients.
• Pacemaker algorithms effectively reduce unnecessary ventricular pacing, highlighting the importance of individualized assessment.