Abstract 12744: Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation
Background: High-grade conduction disturbances (CD) requiring permanent pacemaker (PPM) implantation (impl) occur in up to 34 % of patients (pts) following transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve (MCV).
Aim of the Study: The aim of this study was to asses the anatomical, clinical and ECG predictors of postinterventional PPM impl in pts undergoing TAVI with the MCV .
Methods: In total 198 pts with high surgical risk underwent transfemoral TAVI with the MCV system (26/29/31mm). Pts (23) with pre-existing PPM were excluded leaving 175 pts for retrospectively evaluation for predictors for PPM impl after TAVI. To evaluate procedural data, device position was measured on fluoroscopy as distance between the proximal aspect of the MCV stent frame below the native aortic annulus.
Results: In our study group 48 (27.4%) pts underwent PPM-impl post TAVI.
Before TAVI 19 (10.9 %) of pts showed pre-operative abnormal CD, including first degree AV block, RBBB and LBBB.
Pts with PPM impl showed a significant longer pre-procedural PQ interval versus pts without PPM-impl (201.3 ± 8.9 ms versus 175.7± 4.3 ms, p=0.04).
Pre-existing LBBB was not associated with PPM impl because there was no pt with a pre-existing LBBB in our PMM group. (PMM versus no-PMM: 0 versus 9.8%). Pre existing RBBB showed a slightly enhanced trend in the PPM group but did not reach statistical significance (16.7% versus 5.2%; p=0.05).
The impl depth showed also no significant difference between pts with and without PPM (12.2 ± 0.38 mm versus 11.6 ± 0,21 mm; p= 0.177), only the incidence of post-interventional new LBBB was associated with a deeper impl: LBBB group versus non-LBBB group: 12.05 ± 0,307mm versus 11,15 ± 0,316mm;p= 0.05. The overall rate of new post procedural LBBB) was 38.9%.
In a multivariate logistic regression analysis for predictors of post-interventional PPM impl including pre-PQ time, pre-existing LBBB, pre-existing RBBB , pre existing atrial fibrillation and depth of impl, only pre-PQ time turned out as independent predictor for PMM impl.
Conclusions: Only a prolonged pre-PQ time turned out as independent predictor for PMM impl after TAVI. The impl depth does not predict the need for PMM impl, but is associated with a new-onset LBBB after TAVI .
Author Disclosures: S. Fateh-Moghadam: None. A. Pachlhofer: None. M. Steeg: None. I. Mueller: None. V. Doernberger: None. V. Doernberger: None. M. Gawaz: None. W. bocksch: None.
- © 2014 by American Heart Association, Inc.