Conduction recovery and avoidance of permanent pacing after transcatheter aortic valve implantation.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic stenosis and high surgical risk. Currently, various prosthesis types are available. Atrioventricular block (AVB) requiring pacemaker (PM) implantation is a typical complication after TAVI. This study investigated the recovery of AV node conduction and mid-term outcome of patients with or without PM implantation after TAVI according to prosthesis type.

METHODS

From July 2008 to May 2015, 856 transcatheter heart valves were implanted at our center (age: 80.5±6.1 years; logistic EuroSCORE: 15.4%). These patients were followed up regularly in our outpatient clinic.

RESULTS

PM implantation was performed in 16.9% of patients due to severe conduction disturbances, mainly third-degree AVB. The need for PM implantation differed between the various prosthesis types: Medtronic CoreValve (Medtronic Inc., Minneapolis, MN, USA): 22.8% (n=272), Edwards Sapien XT (Edwards Lifesciences, Irvine, CA, USA): 13.0% (n=262), Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA, USA): 16.2% (n=234), Direct Flow Medical (Direct Flow Medical, Santa Rosa, CA, USA): 7.3% (n=41), St. Jude Medical Portico (St. Jude Medical, St. Paul, MN, USA): 15.4% (n=26), Boston Scientific Lotus (Boston Scientific, Marlborough, MA, USA): 21.4% (n=14) and Medtronic Evolut R (Medtronic Inc., Minneapolis, MN, USA): 14.3% (n=7). Kaplan-Meier analysis for all-cause mortality did not reveal any differences between the various prosthesis types. PM implantation rates declined over the years of experience in a stable intervention team; 45% of PM patients showed sufficient AV node conduction after PM reprogramming at our follow-up examination.

CONCLUSIONS

Mid-term all-cause survival after TAVI seems to be independent of prosthesis type and PM implantation after TAVI. Intrinsic AV node conduction recovers in a significant proportion of patients. Therefore, regular PM interrogations including reprogramming are required to avoid unnecessary permanent right ventricular stimulation.