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Factors predicting persistence of AV nodal block in post‐TAVR patients following permanent pacemaker implantation
Author(s) -
Lader Joshua M.,
Barbhaiya Chirag R.,
Subnani Kishore,
Park David,
Aizer Anthony,
Holmes Douglas,
Staniloae Cezar,
Williams Mathew R.,
Chinitz Larry A.
Publication year - 2019
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13789
Subject(s) - medicine , permanent pacemaker , right bundle branch block , prosthesis , cardiology , valve replacement , complication , implant , left bundle branch block , ventricular outflow tract , conduction abnormalities , cardiac resynchronization therapy , surgery , electrocardiography , heart failure , ejection fraction , stenosis
A common complication of transcatheter aortic valve repair (TAVR) is development of conduction defects requiring pacemaker (PPM) implantation. These defects are not universally permanent. Objective To determine the incidence and predictors of persistent device dependency in patients with PPM implantation following TAVR with a self‐expanding prosthesis. Methods Records of patients who underwent post‐TAVR PPM implantation were reviewed. Patients with persistent complete AV block (AVBIII) one month post‐TAVR were compared to those regaining conduction. Results Between September 2014 and March 2017, 485 patients underwent TAVR with a self‐expanding prosthesis; 77 (15.9%) underwent PPM implantation for AVBIII. Device interrogation at one month was available for 61 patients (79%): 22 (36.1%) had resolution of AVBIII while 39 (63.9%) remained pacemaker‐dependent. Pre‐TAVR right bundle branch block was more frequent in device‐dependent patients (19 of 38, 50% vs 4 of 22, 18%; RR 2.75; P = .01). Device‐dependence was associated with AVBIII as the first postprocedural rhythm (37 of 39, 95% vs 12 of 22, 55%; RR 1.74; P < .0001), earlier implantation (median 1d, IQR: 0‐1.5d vs 2d, IQR: 1.0‐4.0d, P = .0004), and a shorter duration of hospitalization (median 3d, IQR: 2‐3.5d vs 4d, IQR: 2‐5.75d, P = .03). Pacemaker dependence was also associated with a higher prosthesis‐to left ventricular outflow tract (LVOT) diameter (1.45 ± 0.11 vs 1.39 ± 0.07; P = .02) and the lack of prior aortic valvuloplasty (5 of 39, 13% vs 8 of 22, 36%; RR 0.35; P = .03). Conclusions In patients receiving a PPM following self‐expanding TAVR, a long‐term pacing requirement can be predicted from the timing of AV block, existing conduction‐system disease, larger prosthesis‐to‐LVOT diameter, and the lack of aortic valvuloplasty.