Abstract 4514: Postoperative AV Block and Pacemaker Implantation after Transcatheter Aortic Valve Implantation
High grade AV block and consecutive pacemaker (PM) implantation are frequent complications following transcatheter aortic valve implantation (TAVI). We aimed to identify risk factors predicting these complications. For logistic regression analysis, we included 85 patients (mean age 81±7y, EuroScore 24±15%) who underwent TAVI (n=73 transfemoral, n=2 via subclavian artery, n=10 transapical) between June 2007 and May 2008 and who had no previously implanted PM. Of those, 22 (26%) developed postoperative AV block with the need of PM implantation. PM implantation had to be performed more frequently in patients with pathological preoperative ECG findings, such as AV block °I (33% PM implantation) or bundle branch block (39% PM implantation) vs normal ECG (20% PM implantation, n.s.), and in patients receiving a CoreValve (28% PM implantation) vs an Edwards Sapien prosthesis (10% PM implantation, n.s.). Stepwise logistic regression analysis revealed the occurrence of a transient AV block > °I during the TAVI procedure (52% PM implantation) as the only significant independent factor predicting later PM implantation (OR 8.98, CI 2.69 –29.98, p<0.001), while gender, age, EuroScore, prosthesis type and dimensions, annulus diameter and preoperative ECG findings had no significant influence. Patients who experience a transient AV block > °I during TAVI procedures should carefully be monitored postoperatively, as there is a 9fold increased risk of developing high grade AV block with the indication for a PM implantation.