Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement

Rachel M. Kaplan, Ajay Yadlapati, Eric P. Cantey, Rod S Passman, Mark Gajjar, Bradley Paul Knight, Ranya Nabil Sweis, Mark J Ricciardi, Duc Thinh 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

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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 Paul} and Sweis, {Ranya Nabil} and Ricciardi, {Mark J} and Pham, {Duc Thinh} 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 Paul

AU - Sweis, Ranya Nabil

AU - Ricciardi, Mark J

AU - Pham, Duc Thinh

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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