Author + information
- Nader Makki,
- Jenn Dollery,
- Danielle Jones,
- Juan Crestanello and
- Scott Lilly
Atrioventricular block necessitating permanent pacemaker (PPM) placement occurs in up to 5-20% of patients after transcatheter aortic valve replacement (TAVR). Although predictors of pacemaker implantation have been established, there is no broad consensus regarding electrophysiological study (EPS) or PPM implantation for indications other than complete heart block (CHB).
Data derived from a retrospective review of patients undergoing commercial TAVR between 2011 and 2016. We collated patients that underwent in-hospital PPM implantation and a follow up of at least 3 months. Data abstraction was performed for pacemaker indication, timing, and device interrogation for pacemaker dependency on follow up.
A total of 24 patients received in-hospital PPM post-TAVR (14% of total cohort), and mean follow up was 22 months. The mean time from TAVR to PPM implant was 5 days (range 1 -16). Indications for PPM included CHB (16/24, 67%), left bundle branch block and abnormal EPS (HV > 55 msec or heart block; 6/24, 25%), alternating bundle branch block (1/24, 4%) and tachy-brady syndrome (1/24, 4%). Pacemaker dependency (underlying ventricular asystole, complete heart block, or >50% pacing) occurred in 7 (57%) during follow-up, 6 of whom had resting CHB, and one with CHB prompted by EPS.
Pacemaker dependency after TAVR is common among those that exhibited CHB, but not among those with an HV delay > 55 msec during EPS. Although preliminary, these observations are relevant to management of rhythm disturbances after TAVR, and may inform appropriate EPS-driven indications for PPM.
|Patient characteristics||Commercial TAVR Cases Receiving Pacemaker 2011-2016|
|Total number of TAVI cases||171|
|Mean time from TAVI to PPM||5 days (range 1-16 days)|
|Total number of patients who Received EPS prior to PPM N (%)||7 (29%)|
|Mean duration of follow-up post TAVI||22 months (range 9-24)|
|Indications for PPM||N (%)||PM Dependent** on follow-up|
|CHB||16 (67)||7/16 (57%)|
|Abnormal EPS||6 (25)||1/6 (14%)|
|Alternating BBB||1 (4)||0/1 (0%)|
* PM = permanent pacemaker; CHB = complete heart block; EPS = electrophysiological study; BBB = bundle branch block; TAVI = transcatheter aortic valve implantation; N = number.
** underlying ventricular asystole, complete heart block, or >50% pacing.