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Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve
Author(s) -
Zaman Sarah,
McCormick Liam,
Gooley Robert,
Rashid Hashrul,
Ramkumar Satish,
Jackson Damon,
Hui Samuel,
Meredith Ian T.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26857
Subject(s) - medicine , clinical endpoint , cardiology , hazard ratio , permanent pacemaker , valve replacement , incidence (geometry) , aortic valve replacement , aortic valve , prosthesis , stenosis , heart block , aortic valve stenosis , surgery , randomized controlled trial , electrocardiography , confidence interval , physics , optics
Objectives To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded Lotus TM Valve System (Boston Scientific). Background Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single‐centre. Patients with a pre‐existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30‐day incidence of pacemaker requirement (PPM implantation or death while pacing‐dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre‐existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty‐day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre‐existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0–5.7; P = 0.045). Conclusions Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre‐existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors. © 2016 Wiley Periodicals, Inc.