Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System

Background/objectives

To determine pacemaker (PM) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI).

Methods

Single center prospective observational study including 167 patients without previous PM implantation who underwent TAVI with the self-expanding Medtronic CoreValve System (MCS) between November 2005 and February 2011. PM dependency was defined by the presence of a high degree atrioventricular block (HDAVB; second [AV2] and third degree [AV3B]), or a slow (< 30 bpm) or absent ventricular escape rhythm during follow-up PM interrogation.

Results

A total of 36 patients (21.6%) received a new PM following TAVI. The indication for PM was AV2B (n = 2, 5.6%), AV3B (n = 28, 77.8%), postoperative symptomatic bradycardia (n = 3, 8.3%), brady–tachy syndrome (n = 1, 2.8%), atrial fibrilation with slow response (n = 1, 2.8%) and left bundle branch block (n = 1, 2.8%). Long term follow-up was complete for all patients and ranged from 1 to 40 months (median (IQR): 11.5 (5.0–18.0 months). Of those patients with a HDAVB, 16 out of the 30 patients (53.3%) were PM independent at follow-up visit (complete or partial resolution of the AV conduction abnormality). Overall, 20 out of the 36 patients (55.6%) who received a new PM following TAVI were PM independent at follow-up.

Conclusion

Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients.