This article is more than 5 years old. Information may no longer be current.
One-third of patients treated with TAVI device required permanent pacemaker at 30 days
Khawaja M. Circulation. 2011;123:951-960.
Click Here to Manage Email Alerts
Data from the United Kingdom have found that 1 month after CoreValve transcatheter aortic valve implantation, one-third of patients required additional implantation of a permanent pacemaker.
The data were taken from 270 patients who had transcatheter aortic valve implantation (TAVI) with the CoreValve Revalving System (CoreValve, Medtronic) at 10 centers in the United Kingdom. Patients were excluded if they had substantially incomplete data sets or preprocedural permanent pacemaker in situ, leaving 243 patients.
From baseline to after TAVI, the mean QRS duration significantly increased from 105 ± 23 ms to 135 ± 29 ms, as did the left bundle branch block (13% baseline vs. 61% after TAVI). Overall, at 30 days, 81 patients (33.3%) required a permanent pacemaker, with a median time to insertion of 4 days. Among the independent predictors of the need for a permanent pacemaker, according to multivariate analysis, were: periprocedural atrioventricular block (OR=6.29), prolonged QRS duration (OR=3.45), balloon predilatation (OR=2.68) and the use of the larger (29 mm) CoreValve prosthesis (OR=2.50).
The likelihood of insertion of a permanent pacemaker, the researchers wrote, is an acceptable consequence of its anatomic relationship to the intrinsic cardiac conduction system.
“The increased rates of [permanent pacemaker] implantation in patients with post-procedural bundle-branch block and overall median time to implantation … lead us to recommend that these patients be observed for higher-grade conduction disturbances for up to a week post-procedurally, with greatest care taken in those with periprocedural [atrioventricular] block, those receiving the larger 29-mm device and patients with greater interventricular septal diameter,” they said.
 |
Follow CardiologyToday.com on Twitter. |