Abstract 21300: Conduction Disturbances and Need for Pacemaker Implantation after Percutaneous Treatment of Aortic Valve Stenosis using the Medtronic CoreValve ReValving System
Aortic valve stenosis represents the major valve disease in elderly patients in the western countries. Transfemoral aortic valve implantation (TAVI) using Medtronic CoreValve (MCV) represents an alternative to conventional surgery in high risk patients. However, a possible disadvantage might be its deep extension into the left ventricle, possibly causing conduction disturbances. Therefore, the aim was to analyze the occurrence of conduction abnormalities (CAS) after MCS implantation.
Methods/Results: The occurrence of high grade CAS was evaluated analyzing ECG recordings of 325 consecutive TAVI patients treated with the MCS. ECGs and patient records were analyzed with regards to CAS, need for pacemaker implantation and clinical outcome. Already 43 pts (13.2%) of the entire population had a permanent pacemaker implanted prior to the MCV procedure. One-hundred-fourteen pts of the remaining 282 pts received a pacemaker implant after MCS implantation (40.4%) due conduction abnormalities. The decision for pacemaker implantation was made because of an AV-block III in 84.2% (95 out of 114 pts) and 3.5% (4 out of 114 pts) received an ICD system because of symptomatic bradycardia in combination with severely impaired LV function. First grade AV-block combined with new onset of a bundle branch block was the reason for PM implantation in 9.6% (11 out of 114 pts) and 3.5 % (4 out of 114 pts) were treated because of sick sinus syndrome. Four pts developed hemodynamically significant pericardial effusions. In two pts this was managed by percutaneous puncture, in two cases surgical pericardiocentesis had to be performed. The 30day mortality did not differ between patients who received and who did not receive a pacemaker after MCV procedure (p=ns.). There was no difference between the two groups with regard to age, STS- and logistic EuroScore either. However, Pts with pacemaker implantation had longer hospital stay (16±8 days vs. 13±9 days, p=0.015) after MCS as compared to those without.
Conclusions: Conduction disturbances with the need of permanent pacemaker implantation occur frequently after TAVI using the MCS. Further studies are necessary to elucidate factors predicting postprocedural conduction abnormalities requiring pacemaker implantation. .
- © 2010 by American Heart Association, Inc.