Journal Article

Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation

Oreglia, Jacopo, De Carlo, Marco, Petronio, Anna Sonia, Zucchelli, Giulio, Testa, Luca, Klugmann, Silvio, Bedogni, Francesco, De Marco, Federico, Giannini, Cristina, Brambilla, Nedy

2012

Overview

Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing. Of the 47 patients (17.1%) who developed postprocedural complete atrioventricular block, 14 recovered spontaneous atrioventricular conduction <72 hours and did not receive a PPM. Sixty-six patients (24.0%) received a PPM before discharge, and 74 more patients (26.9%) developed a new left bundle-branch block (LBBB). Independent predictors of PPM implantation were as follows: lower CoreValve implantation below the aortic annulus (odds ratio [OR] 1.16/mm, 95% CI 1.03-1.30, P = .01), right bundle-branch block (OR 3.72, 95% CI 1.5-9.2, P = .004), left anterior hemiblock (OR 2.34, 95% CI 1.1-5.1, P = .03), and longer PR interval (OR 1.02/ms, 95% CI 1.00-1.04, P = .03). One-year survival was similar between patients who received a PPM and patients who did not receive a PPM (P = .90), with no case of sudden death in the latter group, and between patients with a new LBBB not receiving a PPM and patients without postprocedural LBBB (P = .37). A high CoreValve implantation level and avoidance of prophylactic pacing in patients with new LBBB without persistent bradyarrhythmias allowed for a relatively low rate of PPM implantation. This conservative approach spared unwarranted pacing and did not affect 1-year survival.

• Publisher: Elsevier Inc,Mosby,Elsevier Limited
• Subject: Aged / Aortic Valve Stenosis - diagnosis / Aortic Valve Stenosis - surgery / Atrioventricular Block - etiology / Atrioventricular Block - physiopathology / Atrioventricular Block - therapy / Biological and medical sciences / Cardiac arrhythmia / Cardiac Catheterization / Cardiology / Cardiology. Vascular system / Cardiovascular / Electrocardiography / Female / Follow-Up Studies / Heart attacks / Heart Conduction System - physiopathology / Heart Rate / Heart Valve Prosthesis Implantation - methods / Hospitalization / Humans / Logistics / Male / Medical sciences / Pacemaker, Artificial - standards / Patients / Postoperative Complications - prevention & control / Practice Guidelines as Topic - standards / Prospective Studies / Prostheses / Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) / Software / Treatment Outcome