Abstract 17748: Predictors of Persistence of Complete Heart Block Post Transcatheter Aortic Valve Replacement
Introduction: Transcatheter aortic valve replacement (TAVR) is an increasingly prevalent therapy in patients with severe symptomatic aortic stenosis (AS) deemed inoperable or at high risk for complications with surgical aortic valve replacement (SAVR). Atrioventricular (AV) conduction disturbances requiring permanent pacemaker (PPM) implantation may complicate TAVR. We report single-center data on 207 consecutive patients undergoing TAVR with placement of the Edward SAPIEN valve who required post-TAVR permanent pacemaker implantation for complete AV block.
Methods: A retrospective analysis of prospectively collected data includes clinical, procedural, echocardiographic, ECG and device interrogation of 207 consecutive patients who underwent TAVR procedure with placement of Edward SAPIEN valve at our institution from March 2012 to February 2016. We excluded 23 patients with prior permanent pacemaker. No patients met guideline indications for pre-TAVR permanent pacing.
Results: A total of 24 patients (13%) required post-TAVR permanent pacemaker. At 30 days post-TAVR, 7 of these patients (29.1%) required 100% ventricular pacing. The remaining 17 (70.9%) patients who received pacemakers had resolution of AV block by 30 days post-TAVR and did not require significant ventricular pacing. All the 7 patients who needed long term significant ventricular pacing had right bundle branch block and 6 of them developed intra procedural complete heart block, where as majority of patient who did not require significant long term ventricular pacing did not have right bundle branch block and did not develop intraprocedural heart block. Different valve sizes were present in both groups.
Conclusions: Despite 13% of post-TAVR patients receiving permanent pacemakers for complete AV block, 70.9% of these patients had resolution of AV block at 30 days post-TAVR and did not require ventricular pacing. Right bundle branch block (RBBB) and Intra-procedural heart block were highly predictive of long term pacing requirements in post TAVR patients who develop complete heart block, where as valve size did not have predictive significance.
Author Disclosures: A. Mourad: None. A. Chu: None.
- © 2016 by American Heart Association, Inc.