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Pacemaker implantation after TAVI: predictors of AV block persistence

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Abstract

Aims

Approximately every fifth patient undergoing transcatheter aortic valve implantation (TAVI) requires a permanent pacemaker (PPM) after the procedure. The aim of this study was to analyse predictors of atrioventricular block III° (AVBIII) persistence with concurrent PPM dependency after TAVI.

Methods and results

Between 2010 and 2015 a total of 1198 patients underwent TAVI at the Kerckhoff Heart and Thorax Center, Germany. After exclusion of patients with prior PPM (n = 173) 14.7% (n = 176) of the patients underwent PPM implantation after the procedure. Independent predictors of PPM implantation were pre-existing right bundle branch block (RBBB, p < 0.001) and implantation of a CoreValve prosthesis (p < 0.001). A subgroup of patients with a newly implanted PPM (n = 102) were followed-up for a median of 73 (IQR 62–85) days. The leading indication for PPM implantation was AVBIII in 74.5% (76/102). Of these patients only 22.4% (17/76) had persistent AVBIII at follow-up. Predictors of AVBIII persistence were prior RBBB (p = 0.04), postdilatation (p = 0.006) and higher mean aortic valve gradient prior to implantation (p = 0.013). PPMs were implanted earlier in patients with persisting AVBIII [1 day (IQR0–2.5) vs. 4 days (IQR2–7); p < 0.001]. Early PPM implantation after TAVI was the only independent predictor of persistent AVBIII [OR 1.36 (95% 1.05–1.75); p = 0.02].

Conclusion

The long-term persistence of AVBIII is generally low after TAVI. Therefore, it may be wise to postpone the indication for PPM implantation for a couple of days. The only predictors of a lack of recovery of the AVB are prior RBBB, higher mean aortic valve gradients and postdilatation of the prosthesis.

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Acknowledgements

We thank Elizabeth Martinson, Ph.D., of the KHFI Editorial Office for her editorial assistance.

Author information

Author notes

  1. Luise Gaede and Won-Keun Kim are contributed equally.

Authors and Affiliations

  1. Department of Cardiology, St.-Johannes-Hospital, Medizinische Klinik I, Johannesstraße 9-13, 44137, Dortmund, Germany

    Luise Gaede, Johannes Blumenstein & Helge Möllmann

  2. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Won-Keun Kim, Christoph Liebetrau, Johannes Sperzel, Alexander Berkowitsch & Christian Hamm

  3. Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Won-Keun Kim & Thomas Walther

  4. Department of Cardiology and Angiology, Medical Clinic I, University of Giessen, Giessen, Germany

    Oliver Dörr, Christian Hamm & Holger Nef

  5. Department of Cardiology, University of Oldenburg, Oldenburg, Germany

    Albrecht Elsässer

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  1. Luise Gaede
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  2. Won-Keun Kim
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  3. Christoph Liebetrau
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Corresponding author

Correspondence to Helge Möllmann.

Ethics declarations

The ethics board of the state of Hessen, Germany, approved the study (FF 87/2010), which complies with the Declaration of Helsinki.

Conflict of interest

Helge Möllmann received speaker honoraria and/or travel grants from Edwards Lifesciences, St. Jude Medical, Boston Scientific (former Symetis SA). Luise Gaede and Johannes Blumenstein received travel grants from Edwards Lifesciences, St. Jude Medical, Boston Scientific (former Symetis SA). Won Keun Kim is a proctor for St. Jude Medical and Boston Scientific (former Symetis SA). Christian Hamm is part of the Medtronic Advisory Board. Johannes Sperzel received lecture honoria from Abbott and Zoll. All other authors have no conflict of interest regarding the submitted work.

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Gaede, L., Kim, WK., Liebetrau, C. et al. Pacemaker implantation after TAVI: predictors of AV block persistence. Clin Res Cardiol 107, 60–69 (2018). https://doi.org/10.1007/s00392-017-1158-2

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  • DOI: https://doi.org/10.1007/s00392-017-1158-2

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