Permanent pacemaker insertion after transcatheter aortic valve implantation.

Abstract

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure used to treat patients with symptomatic aortic stenosis. One of complications of TAVI is cardiac conduction abnormalities which requires permanent pacemaker insertion (PPI). This study determined the rate and contributing factors leading to PPI in patients after TAVI procedure. Method: We retrospectively analysed 196 patients that underwent elective TAVI from March 2010 to March 2016 at Epworth hospital. Eighteen patients with pre-operative pacemakers were excluded from the study leaving 178 patients for subsequent analysis. Statistical analysis was performed with MedCalc and GraphPad software. Results: The mean age of 178 TAVI patients was 84.4 ± 5.2 years with 46% male patients. The Core Vale prosthesis (CVP) was used in 154 patients whereas 24 patients received the Evolut R prosthesis (ERP). The mean Society of Thoracic Surgeons' (STS) risk score for all patients was 5.1±3.1. A total of 53 (30%) patients suffered from cardiac arrhythmias requiring PPI post-TAVI. The average timeframe for PPI was 3.1±5.0 days post-TAVI with 89% occurring within a week. Atroventricular (AV) block accounted or 68% of cases and majority of the AV blocks documented were complete hart blocks. PPI was increased with the use of CVP (33%) as compared to ERP (13%) (P=0.08, RR 046, 95%CI 0.1‛a1.1). The risk also increased with larger prosthetic valves (P=0.01, 95%CI - 3.6‛a-1.3) and deeper valve deployment into the aortic annulus (P=0.0001, 95%CI - 3.6a‛-1.3).