Abstract 14580: Predictors for Permanent Pacemaker Implantation After Corevalve Implantation in Patients Without Preexisting ECG Conduction Disturbances. The Role of a New Echocardiographic Index
Purpose: The aim of this study was to assess the anatomical and electrocardiograhical (ECG) predictors of postoperative permanent pacemaker (PPM) implantation, in patients without ECG conduction disturbances prior to the Medronic CoreValve (MCV) implantation.
Methods: Ninety eight consecutive patients that underwent TAVI with MCV from two tertiary centers were included in the study. Clinical data, preoperative ECG conduction disorders, echocardiographic patterns, and procedural data were tested as predictors of PPM implantation after TAVI. Optimal (high) device position was defined on fluoroscopy as final position of the proximal aspect of the MCV stent frame 4-8 mm below the native aortic annulus. Procedural echocardiographic parameters [transvalvular gradients, ejection fraction, aortic and mitral regurgitation, pulmonary artery systolic pressure, diameter of left ventricular outflow tract (LVOT), and area of the aortic valve (including annulus)] were measured by using usual techniques. Patients with preexisting pacemaker or with bifascicular block were excluded from the study.
Results: In patients with PPM implantation the depth of implantation was increased compared to patients without PPM (9.38±3.72 versus 7.53±1.84mm, p=0.001). Optimal implantation (<8 mm in depth) of the MCV was performed in 69 patients (70.40%). In these patients the rate of PPM was 31.88% versus 87.03% of patients without optimal placement (p=0.0001). Patients with PPM had lower LVOT/annulus ratio compared to those without PPM (0.86±0.70 versus 0.91±0.52, p=0.0001). Patients with optimal implantation of the MCV and high LVOT/annulus ratio (≥0.89) had low incidence of PPM implantation (n=4/39, 10.25%). Patients with optimal implantation and low LVOT/annulus ratio had similar incidence of PPM implantation (n=18/30, 60%) to patients with non-optimal implantation and high LVOT/annulus ratio (n=8/13, 61.53%). The highest rate of PPM implantation was found in the group of patients with non-optimal implantation and low LVOT/annulus ratio (n=14/16, 87.5%). (p <0.05).
Conclusions: The level of implantation of the MCV and the LVOT/annulus ratio are independent predictors of PPM implantation in patients undergoing TAVI with the MCV.
- © 2013 by American Heart Association, Inc.