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Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement

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Abstract

Purpose

Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring pacemaker (PPM) implantation are a known complication and may be reversible. Therefore, we sought to evaluate the incidence and predictors for atrioventricular (AV) conduction recovery after TAVR.

Methods

A single-center, retrospective study of patients undergoing PPM implantation for conduction disorders after TAVR between June 2011 and March 2019. Conduction recovery was defined as ≤ 1% ventricular pacing (VP) on follow-up PPM interrogation.

Results

A total of 110 patients (mean age 83.6 ± 6.6 years, 46.8% female) were included. At a median follow-up of 438 days (interquartile range [IQR] 111–760 days), 35 patients (32%) had conduction recovery, with 50% of these occurring within the first 6 months. On multivariate analysis, predictors of conduction recovery include female sex (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.01–6.4, p = 0.048), non-VP/non-complete heart block rhythm immediately post-TAVR (HR 5.2, 95% CI 1.5–18.1, p = 0.011), normal sinus rhythm 7 days post-TAVR (HR 3.9, 95% CI 1.7–9.2, p = 0.002), and smaller valve size (mm) (HR 0.81, 95% CI 0.7–0.996, p = 0.045). Significant narrowing of the QRS and resolution of new-onset left bundle branch block within 1 month post-TAVR occurred in those with conduction recovery on PPM interrogation.

Conclusions

One-third of patients receiving new PPM implantation have conduction recovery after TAVR, with 50% occurring within the first 6 months. Patient gender, valve size, and rhythm on serial ECGs after TAVR can help identify patients that may recover AV conduction. A conservative approach rather than immediate PPM implantation may be considered in these patients.

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Abbreviations

AV:

Atrioventricular

CHB:

Complete heart block

ECG:

Electrocardiogram

LBBB:

Left bundle branch block

LVEF:

Left ventricular ejection fraction

LVOT:

Left ventricular outflow tract

NSR:

Normal sinus rhythm

PPM:

Permanent pacemaker

RBBB:

Right bundle branch block

TAVR:

Transcatheter aortic valve replacement

TTE:

Transthoracic echocardiogram

VP:

Ventricular pacing

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Authors and Affiliations

  1. Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Derek Q. Phan, Jesse Goitia & Ming-Sum Lee

  2. Division of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Nigel Gupta

  3. Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA

    Vicken Aharonian, Prakash Mansukhani, Naing Moore, Somjot S. Brar & Ray Zadegan

Authors
  1. Derek Q. Phan
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Corresponding author

Correspondence to Ray Zadegan.

Ethics declarations

This study was approved by the Institutional Review Board of Kaiser Permanente Southern California.

Conflict of interest

Dr. Vicken Aharonian is a consultant for Medtronic. The remaining authors have no conflicts of interest.

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Phan, D.Q., Goitia, J., Lee, MS. et al. Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement. J Interv Card Electrophysiol 61, 365–374 (2021). https://doi.org/10.1007/s10840-020-00813-y

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  • DOI: https://doi.org/10.1007/s10840-020-00813-y

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