永久心脏起搏器植入术后并发症的原因分析及护理对策

目的探讨永久心脏起搏器植入术后并发症及其原因,并总结护理对策。方法回顾分析2005年1月至2007年2月54例永久心脏起搏器植入术患者的临床和护理资料。结果术后发生并发症9例(11例次),发生率为20.4%(11/54),其中电极脱位5例次(45.4%),囊袋积血3例次(27.3%),起搏器感知功能障碍2例次(18.2%),起搏器综合征1例次(9.1%);所有并发症经相应处理后,患者均恢复正常。结论永久心脏起搏器植入术后并发症以电极脱位和囊袋积血为多见;熟悉永久起搏器植入术相关理论知识、术后密切观察和护理,对预防及减少术后并发症的发生有重要作用。     

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-Up

Background: Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent.
Methods: We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 ± 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients.
Results: Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 ± 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001).
Conclusions: Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge.     

Complications Related to Permanent Pacemaker Therapy

This study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent. Eleven percent of patients needed an invasive procedure due to an early or late complication.     

Delayed complications following pacemaker implantation

Acute complications resulting from permanent pacemaker implantation are well known and include perforation of the right atrium or right ventricle. Recently, several reports have described the occurrence of perforation and pericarditis as late complications following pacemaker implantation. These complications may occur days to weeks following uncomplicated pacemaker implantation and may lead to death if they are not recognized early. Five patients with late complications caused by active-fixation leads are reported and the clinical features of their presentation and management are reviewed. Late perforation of the right atrium or right ventricle is an uncommon complication after pacemaker implantation but should be suspected by the general cardiologist in a patient who has a device implanted within a week to several months prior to the development of chest pain.     

Antibiotic Prophylaxis for Pacemaker Implantation: A Prospective Randomized Trial

Prophylactic antibiotics are frequently prescribed for patients undergoing permanent pacemaker implantation even though data confirming their effectiveness are limited. Five hundred patients requiring elective permanent pacemaker implantation or generator replacement were prospectively randomized either to receive or not receive prophylactic antibiotic treatment at the time of implantation. The implantation site was treated with 10% povidone-iodine solution and 0.5% alcoholic chlorhexidine preoperatively. The wound were inspected for evidence of infection at 3 days and 1, 3, 6 and 12 months postimplantation. Three patients (two receiving prophylactic antibiotics and one no antibiotics) developed pacemaker pocket infection; Staphylococcus aureus was the pathogenic organism in each case (P = 0.56). Eighteen patients developed clinical evidence of superficial wound inflammation requiring antibiotic treatment but not pacemaker removal. Six had received prophylactic antibiotics and 12 had not (P = 0.27). We conclude that pacemaker pocket infection is unusual with careful preoperative skin preparation and close postoperative follow-up. Under these circumstances prophylactic antibiotic treatment is of no practical value.     

Atrioventricular Block Occurring Late After Heart Transplantation: Presentation of Three Cases and Literature Review

Sinus node dysfunction is a well-known occurrence following orthotopic heart transplantation, but atrioventricular block is rarely described. We compare the incidence and clinical presentation of atrioventricular block and sin us node dysfunction among the first 200 consecutive patients receiving heart transplantation at the University of Utah. Two of 200 patients (1%) required pacemaker implantation for symptomatic atrioventricular block compared to 13 of 200 (6.5%) who required pacemaker for symptomatic sinus node dysfunction. Of the patients with atrioventricular block, one had intermittent Mobitz II second-degree atrioventricular block and one had high grade atrioventricular block without ventricular escape. The most striking difference between the patients with atrioventricular block and those with sinus node dysfunction was the interval between transplantation and pacemaker implantation; time to pacemaker implantation in the atrioventricular block patients was 955 and 810 days compared to a median time of 26 days for sinus node dysfunction patients (P = 0.037). The patients requiring permanent pacemaker implantation were similar to those not requiring pacemaker implantation with respect to age, sex, ischemic time, and donor age. None of the patients requiring permanent pacemaker implantation was on amiodarone therapy within 2 months of transplant.     

A new method for the treatment of supraventricular rhythm disorders

Initial experience of His-bundle ablation is presented in 12 patients with intractable supraventricular arrhythmias which were not amenable to treatment with conventional drugs. In 8 patients His-bundle ablation resulted in total AV-block and in 2 patients significant improvement without total AV-block was achieved. During long-term follow-up (mean 5.3 months) tachycardia recurred in 1 patient with total AV-block resulting in an overall success rate of 75%. A permanent pacemaker was implanted in 10 patients. 1 patient developed deep leg vein thrombosis as a direct result of this procedure and in 2 patients there were complications due to pacemaker implantation. His-bundle ablation appears to be a promising tool in the management of intractable supraventricular tachycardia.     

Upgrade of single chamber pacemakers with transvenous leads to dual chamber pacemakers in pediatric and young adult patients

Children with single chamber pacemakers, in adolescence and young adulthood, may be upgraded to dual chamber systems, but there are no published data about indications, timing, and complications. Upgrading was attempted in 18 patients with transvenous pacing leads. A retrospective analysis of all collected data was performed. At initial pacemaker implantation (mean +/- SD, 9.3 +/- 4.1 years), the pacing mode was VVIR (n = 13 patients) and AAI/AAIR (n = 5 patients). After 72 +/- 41 months of follow-up, at the age of 15.5 +/- 5.2 years, upgrade was undertaken because of the patient's age at elective generator replacement (n = 3 patients), ventricular dysfunction (n = 7), syncope/presyncope (n = 3) in patients with VVIR pacing, atrioventricular block (n = 2), and/or drug refractory supraventricular tachyarrhythmias (n = 4) in patients with atrial pacing. In comparison with single chamber pacemaker implantations, the average procedural time and the average fluoroscopy time were not significantly longer. All suitable preexisting leads were incorporated in the new pacing system. Leads were inserted via the ipsilateral subclavian vein in 16 patients. Venous occlusion was found in two patients: in the first the procedure was not performed; in the second, the contralateral vein was used and the old lead was abandoned. There were no procedural complications. During a follow-up of 14 +/- 11 months, ventricular dysfunction worsened in five of seven patients; other patients benefitted symptomatically. In conclusion, pacemaker upgrade is technically challenging but feasible and safe and may be beneficial for some patients.     

Superior vena cava stenting and transvenous pacemaker implantation (stent and pace) after the Mustard operation

Summary The Mustard operation for transposition of the great arteries is associated with good long-term survival. Typical complications at follow-up include progressive loss of sinus node function requiring permanent pacemaker implantation, and systemic venous pathway obstruction often precluding a transvenous approach to pacing. We report on 7 patients (median age 14.1; range 5–19) with bradyarrhythmia requiring permanent pacemaker implantation with associated stenosis (n = 6) or occlusion (n = 1) of the superior vena cava, in whom stent implantation relieved the obstruction and facilitated subsequent transvenous permanent pacing. In five of them stenting and pacemaker implantation were performed during a single procedure; two patients underwent elective pacemaker implantation 6 weeks later. In one patient the pacemaker had to be explanted due to pacemaker pocket infection. In the others the follow-up has been uneventful, with excellent chronic pacing thresholds and appropriate sensing. Two patients have had their generator replaced electively. We conclude that stenting of the SVC stenosis allows implantation of transvenous pacemaker leads with good intermediate term results in patients with a Mustard operation for transposition of the great arteries.     

Long-Term Follow-Up of Patients Treated with VVI Pacing and Sequential Pacing with Special Reference to VA Retrograde Conduction

The aim of this prospective study is comparing long-term prognosis in patients implanted with a WI pacemaker (group A) with those implanted with a sequential pacing device, AAI or DDD, (group B). Both groups of 45 patients each, were comparable as regards to age, sex, pacing indications, underlying heart disease, and technical conditions of implantation and were followed-up over 55 months. Atrial arrhythmias (A.A.) incidence was higher in group A: 24. 4% than group B: 8.8% (P < 0.05). Arterial embolisms (A.E.) occurred in group A patients only. Worsening or occurrence of exercise limitation was more frequent in group A: 35.6% as compared to group B: 13.3% (P < 0.05) and deaths related to these complications, occurred in seven cases in group A versus four cases in group B. In group A, all patients who experienced a worsening or occurrence of an A.A. or an A.E., had a ventriculoatrial condLction (VAC). No statistical difference was observed in worsening or occurrence of exercise limitation between patients with VAC and those without VAC: nine (42.8%) and seven (29.2%) but they respectively experienced at least one complication in 16 cases (76.2%) and seven cases (29.2%) (P < 0.01). In conclusion, Jong-term prognosis in patients implanted with VVI pacing as compared to patients implanted with sequential pacing is poorer. The presence of VAC in patients treated with permanent WI pacing is a major factor for complications and deaths related to A.E. and cardiac failure. Thus WI pacing should be avoided in patients with VAC.     

Long-Term Thrombosis after Transvenous Permanent Pacemaker Implantation

To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long-term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow-up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty-one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long-term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.     

Transvenous Pacing in Children Weighing Less than 10 Kilograms

Pacemakers are used in small children with increasing frequency for the treatment of life-threatening bradyarrhythmias. The epicardial approach is generally preferred in these patients, to avoid the risks of vessel thrombosis. We examined the feasibility and safety of transvenous pacemaker implantation in children weighing <10 kg, via subclavian puncture, using a 4 Fr sheath introduced after a venogram was performed to evaluate the vein diameter. Progressive dilation with 5, 6, and 7 Fr sheaths preceded the insertion and placement of the endocardial lead. A subaponeurotic pocket was created in the abdominal or pectoral regions, depending upon the patient's size. Between 2001 and 2007, we treated 12 patients (median age = 16 months; range 1–32; median weight = 7.9 kg; range 2.3–10.0; 7 males), of whom four weighed <5 kg. Indications for permanent pacing included postsurgical complete atrioventricular block (n = 8), sinus node dysfunction (n = 2), congenital atrioventricular block (n = 1), and long QT syndrome (n = 1). Single-chamber pacemakers were implanted in 10, and dual-chamber pacemakers in two patients. The patients were evaluated at 48 hours, 10 days, and at 3 and 6 months. The mean follow-up was 31.8 ± 23.5 months. There were no procedural complications. Lead dislodgment occurred in one patient and required replacement of the ventricular lead. One patient died from septicemia. Endocardial pacemaker implantation was feasible and safe in children weighing <10 kg. This procedure is less invasive than the standard epicardial approach.     

Incidence of Coronary Artery Disease and Necessity of Revascularization in Symptomatic Patients Requiring Permanent Pacemaker Implantation

Abstract Background and Purpose:   The cause of severe cardiac conduction disturbances or sinus node dysfunction is often unknown. The objective of this study was to assess the incidence of coronary artery disease (CAD) and the necessity of revascularization in patients with symptomatic bradycardia requiring permanent pacemaker implantation and to try to find a causal association between the need for a pacemaker and the presence of CAD. Patients and Methods:   From January 2002 to December 2005, 507 pacemakers were implanted due to symptomatic bradycardia. In the presence of at least one atherosclerotic risk factor, patients were recommended to undergo coronary angiography. Each patient unterwent exercise or dobutamine echocardiography to detect myocardial ischemia. Results:   212 of the 507 patients (42%) with permanent pacemaker implantation (141 men, mean age 70 ± 9 years) underwent coronary angiography within 2 months before or after pacemaker implantation. Twelve patients (6%) had a normal angiogram. No significant CAD was found in 37 patients (17%), and significant narrowing of the coronary arteries in 150 (71%). Conservative treatment was recommended in 128 patients (60%), 40 patients (19%) were treated with percutaneous coronary intervention, and 44 patients (21%) underwent coronary artery bypass grafting. Conclusion:   The data indicate that patients with severe conduction disturbances or sinus node dysfunction requiring permanent pacemaker implantation are more likely to have CAD with subsequent myocardial revascularization in the presence of at least one atherosclerotic risk factor. A causal association between the need for pacemaker and CAD could not be established from the results.      

Long-Term Follow-Up of Patients Treated By Radiofrequency Ablation of the Atrioventricular Junction

JENSEN, S.M., et al .: Long-Term Follow-Up of Patients Treated By Radiofrequency Ablation of the Atrioventricular Junction . Radiofrequency ablation of the AV conduction tissue (His-bundle ablation) is an accepted treatment for therapy resistant atrial fibrillation/flutter. However, data on the long-term effects of the procedure are limited. We followed 50 patients for a mean of 17 months after AV junction ablation. The indication was treatment resistant atrial fibrillation or flutter. The patients underwent a standardized interview performed by two nurses. Health care was studied via the in-patient register. Subjective improvement was reported by 88% and the number of days in hospital per year was reduced from 17 to 7. The use of antiarrhythmic drugs was reduced by 75%. If the reduction in costs of drugs and days in hospital is compared with the cost of the ablation and the pacemaker implantation, breaking even is achieved after 2.6 years. We could not confirm that patients with paroxysmal atrial fibrillation note less improvement than those with chronic fibrillation. Conclusion: Ablation of the AV junction is a cost effective treatment with good long-term results and relatively few complications. Recommendations: Chronic atrial fibrillation: If sinus rhythm cannot be established and in cases in which heart rate regulating drugs have been ineffective, ablation of the AV junction with implantation of a VVIR pacemaker is recommended. Paroxysmal atrial fibrillation: If the patient despite treatment with antiarrhythmic drugs continues to have symptomatic episodes of atrial fibrillation, then AV junction ablation with implantation of a permanent pacemaker is recommended. Patients who have self-limiting episodes of atrial fibrillation should be given a DDDR pacemaker with an automatic mode switch. Patients who do not have self-limiting attacks and require DC conversion, should receive a VVIR pacemaker     

Complications Associated with Retained Pacemaker Leads

Retention of functionless pacemaker leads may occur following mechanical or infective problems (potentially or definitely infected) or after electrical failure of the lead. One hundred nineteen patients with a pacemaker lead (or leads) retained between 1970 and 1990 were reviewed retrospectively. Lead retention after an intervention dictated by potential or definite infection of the pacing system resulted in complications in 27 of 53 patients (51%), which in 22 patients (42%) were major (septicemia, superior vena cava syndrome, and further surgery under general anesthesia for recurrent "infective" problems) including three deaths. Complications were less likely if lead retention occurred after electrical failure with three minor and two major (surgery under general anesthesia, superior vena cava syndrome) complications in 66 patients (P less than 0.001). Bacteriology of swabs taken at the time of retention in the patients with potential or definite infection was unhelpful in predicting future complications: 8/18 patients (44%) whose swabs were negative had complications of which 5/18 (28%) were major. In our experience retention of functionless pacemaker leads after an intervention dictated by potential or definite infection of the pacing system, is associated with significant morbidity and mortality and should be avoided.     

Endocardial pacemaker implantation in infants weighing < or = 10 kilograms

Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.     

The Underlying Heart Rhythm in Patients with an Artificial Cardiac Pacemaker

One-hundred forty-two patients with atrioventricular block (AVB) and 61 patients with sick sinus syndrome (SSS) were followed for an average of 50 months after permanent pacemaker insertion. Their underlying heart rhythms (UHR) were evaluated repeatedly by chest wall stimulation (CWS). A deficient UHR was defined as ventricular asystole lasting 4 seconds or longer. The underlying conduction disturbance increased in 14% of AVB patients, decreased in 14%, and remained constant in 68%. The occurrence of Adams-Stokes attacks before pacemaker implantation was associated with a higher incidence of deficient UHR both in AVB and SSS; a deficient UHR was seen more frequently in AVB than in SSS. Among AVB patients (1) atrial fibrillation, flutter or tachycardia and (2) sinus rhythm with incomplete AVB, especially Mobitz 1, when present before pacemaker implantation, were associated with a significantly lower incidence of deficient UHR during subsequent pacing in comparison with other AVB patients. CWS is a non-invasive method which allows the evaluation of UHR and which can contribute to the early recognition of pacemaker-dependent patients.     

An approach to ablate and pace:AV junction ablation and pacemaker implantation performed concurrently from the same venous access site

BACKGROUND: Atrioventricular junction (AVJ) ablation combined with permanent pacemaker implantation (the "ablate and pace" approach) remains an acceptable alternative treatment strategy for symptomatic, drug-refractory atrial fibrillation (AF) with rapid ventricular response. This case series describes the feasibility and safety of catheter ablation of the AVJ via a superior vena caval approach performed during concurrent dual-chamber pacemaker implantation. METHODS: A total of 17 consecutive patients with symptomatic, drug-refractory, paroxysmal AF underwent combined AVJ ablation and dual-chamber pacemaker implantation procedure using a left axillary venous approach. Two separate introducer sheaths were placed into the axillary vein. The first sheath was used for implantation of the pacemaker ventricular lead, which was then connected to the pulse generator. Subsequently, a standard ablation catheter was introduced through the second axillary venous sheath and used for radiofrequency (RF) ablation of the AVJ. After successful ablation, the catheter was withdrawn and the pacemaker atrial lead was advanced through that same sheath and implanted in the right atrium. RESULTS: Catheter ablation of the AVJ was successfully achieved in all patients. The median number of RF applications required to achieve complete AV block was three (range 1-10). In one patient, AV conduction recovered within the first hour after completion of the procedure, and AVJ ablation was then performed using the conventional femoral venous approach. There were no procedural complications. CONCLUSION: Catheter ablation of the AVJ can be performed successfully and safely via a superior vena caval approach in patients undergoing concurrent dual-chamber pacemaker implantation.     

心脏起搏器植入患者随访中的健康教育需求和对策

目的调查并分析心脏起搏器植入患者出院后的健康教育需求,探讨健康教育参与的必要性和可行性。方法采用方便抽样的方法,抽取2008年1-10月在陕西省安康市中心医院心内科安装永久性心脏起搏器后随访的108例患者进行健康教育需求问卷调查。结果所有患者都有起搏器健康教育知识需求（100%）;1年内随访患者的需求排前5位的是：如何随访（100%）、对日常生活的影响（100%）、家用电器对起搏器有何影响（100%）、并发症如何观察和预防（100%）、出院后的活动及功能锻炼（100%）;教育方式需求度最高的是医护人员当面指导和小册子等文字说明。1年后随访患者的需求排列前5位的是：如何进行自检（89.2%）、介意别人把自己看成＂起搏器植入患者＂（86.1%）、如何维护（83.1%）、担心故障（80.0%）、更换起搏器的指征和注意事项（75.3%）;教育方式需求度最高的是同种患者互相交流、电话咨询。结论心脏起搏器植入患者随访中健康教育需求度很高,应根据患者术后的不同阶段选择有针对性的健康教育内容和方式。     

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self‐Expanding Bioprosthesis

Background: Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single‐center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self‐expanding bioprosthesis. Methods: From August 2007 to October 2009, 32 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV) System (Medtronic Inc., Minneapolis, MN, USA). Three patients paced at baseline and two cases of procedure‐related mortality were excluded. We analyzed the 12‐lead electrocardiogram at baseline, immediately after procedure and at discharge. Requirements for PPM were documented and potential clinical, electrophysiological, echocardiographic, and procedural predictors of PPM requirement were studied. Results: After TAVI, eight patients (29.6%) required PPM implantation due to high‐grade atrioventricular (AV) block. The prevalence of left bundle branch block increased from 13.8% to 57.7% directly after implantation (P = 0.001). Need for PPM was correlated to the depth of prosthesis implantation (r = 0.590; P = 0.001). At a cutoff point of 10.1 mm, the likelihood of pacemaker could be predicted with 87.5% sensitivity and 74% specificity and a receiver operator characteristic curve area of 0.86 ± 0.07 (P = 0.003). Of the seven patients with preexisting right bundle branch block (RBBB), four (57.1%) required PPM implantation after TAVI. Conclusions: High‐grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high‐grade AV block and subsequent pacemaker implantation. (PACE 2010; 1364–1372)