Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

Rachel M. Kaplan, Ajay Yadlapati, Eric P. Cantey, Rod S. Passman, Mark Gajjar, Bradley P. Knight, Ranya Sweis, Mark J. Ricciardi, Duc T. Pham, Andrei Churyla, S. Chris Malaisrie, Charles J. Davidson, James D. Flaherty*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high-grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long-term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high-grade or complete AV block after TAVR who remain dependent on the PPM in follow-up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon-expandable, 18.1% self-expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow-up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self-expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow-up (< 30 days). The use of self-expanding valves and PBD are associated with a markedly increased risk of PPM dependency.

Original languageEnglish (US)
Pages (from-to)146-152
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Atrioventricular Block
Dilatation
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis

Keywords

  • conduction recovery
  • pacemaker
  • postballoon dilation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{43fb14508ca24c869fc1af41e682301e,
title = "Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement",
abstract = "Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high-grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long-term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high-grade or complete AV block after TAVR who remain dependent on the PPM in follow-up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9{\%} balloon-expandable, 18.1{\%} self-expandable valve), 67 (13.1{\%}) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3{\%}) were dependent at first follow-up and only 9/41 (21.9{\%}) at 1 year. PPM dependency was more common after a self-expanding valve (76.9{\%} vs 31.5{\%}, P < 0.01), in those who underwent PBD (66.7{\%} vs 24.4{\%}, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5{\%} vs 7.4{\%}, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow-up (< 30 days). The use of self-expanding valves and PBD are associated with a markedly increased risk of PPM dependency.",
keywords = "conduction recovery, pacemaker, postballoon dilation, transcatheter aortic valve replacement",
author = "Kaplan, {Rachel M.} and Ajay Yadlapati and Cantey, {Eric P.} and Passman, {Rod S.} and Mark Gajjar and Knight, {Bradley P.} and Ranya Sweis and Ricciardi, {Mark J.} and Pham, {Duc T.} and Andrei Churyla and Malaisrie, {S. Chris} and Davidson, {Charles J.} and Flaherty, {James D.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1111/pace.13579",
language = "English (US)",
volume = "42",
pages = "146--152",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

AU - Kaplan, Rachel M.

AU - Yadlapati, Ajay

AU - Cantey, Eric P.

AU - Passman, Rod S.

AU - Gajjar, Mark

AU - Knight, Bradley P.

AU - Sweis, Ranya

AU - Ricciardi, Mark J.

AU - Pham, Duc T.

AU - Churyla, Andrei

AU - Malaisrie, S. Chris

AU - Davidson, Charles J.

AU - Flaherty, James D.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high-grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long-term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high-grade or complete AV block after TAVR who remain dependent on the PPM in follow-up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon-expandable, 18.1% self-expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow-up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self-expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow-up (< 30 days). The use of self-expanding valves and PBD are associated with a markedly increased risk of PPM dependency.

AB - Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis. A frequent complication of TAVR is high-grade or complete atrioventricular (AV) block requiring a permanent pacemaker (PPM). There are little data on the long-term dependency on pacing after TAVR. The objective of this study was to determine the proportion of patients receiving a PPM for high-grade or complete AV block after TAVR who remain dependent on the PPM in follow-up and to determine any risk factors for, particularly the effect of postballoon dilation (PBD) on, pacemaker dependency. Methods: Of 594 consecutive patients without prior PPM undergoing TAVR (81.9% balloon-expandable, 18.1% self-expandable valve), 67 (13.1%) received a PPM after TAVR. PPM dependency was defined as AV block with a ventricular escape rate of ≤ 40 beats/min. Patient and procedural characteristics were examined according to PPM dependency status. Results: Of the 67 patients who received a PPM within 10 days after TAVR, 27/67 (40.3%) were dependent at first follow-up and only 9/41 (21.9%) at 1 year. PPM dependency was more common after a self-expanding valve (76.9% vs 31.5%, P < 0.01), in those who underwent PBD (66.7% vs 24.4%, P < 0.01), and in patients in persistent complete AV block at PPM implantation (62.5% vs 7.4%, P < 0.01). Conclusions: Fewer than half of patients who receive a new PPM following TAVR are pacemaker dependent at early follow-up (< 30 days). The use of self-expanding valves and PBD are associated with a markedly increased risk of PPM dependency.

KW - conduction recovery

KW - pacemaker

KW - postballoon dilation

KW - transcatheter aortic valve replacement

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U2 - 10.1111/pace.13579

DO - 10.1111/pace.13579

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