Need for Permanent Pacemaker as a Complication of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Elderly Patients With Severe Aortic Stenosis and Similar Baseline Electrocardiographic Findings

doi:10.1016/j.jcin.2012.03.004

JACC: Cardiovascular Interventions

Volume 5, Issue 5, May 2012, Pages 540-551

https://doi.org/10.1016/j.jcin.2012.03.004 Get rights and content

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Objectives

The aim of this study was to compare the incidence and predictive factors of complete atrioventricular block (AVB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).

Background

No data exist on the need for PPI after TAVI versus SAVR in patients with similar baseline electrocardiographic (ECG) findings.

Methods

A total of 411 patients with severe aortic stenosis (AS) and no prior pacemaker who underwent TAVI with the balloon-expandable Edwards valve (Edwards Lifesciences, Irvine, California) were matched (1:1) with 411 elderly patients with severe AS who underwent isolated SAVR on the basis of baseline ECG findings. The incidence, reasons, and predictive factors for PPI within 30 days after the procedure were compared between groups.

Results

Mean age was similar in both groups (p = 0.11), and the TAVI group had a higher Society of Thoracic Surgeons score (p < 0.001). The rate of new PPI was higher after TAVI (7.3%) compared with SAVR (3.4%), p = 0.014. Complete AVB and severe symptomatic bradycardia, respectively, were the reasons for PPI in the TAVI (5.6% and 1.7%, respectively) and SAVR (2.7% and 0.7%, respectively) groups (p = 0.039 for complete AVB, p = NS for symptomatic bradycardia). The presence of baseline right bundle branch block was the only variable associated with PPI in the TAVI group (odds ratio: 8.61, 95% confidence interval: 3.14 to 23.67, p < 0.0001), whereas no variable was found in the SAVR group.

Conclusions

Transcatheter aortic valve implantation was associated with a higher rate of complete AVB and PPI compared with SAVR in elderly patients with severe AS and similar baseline ECG findings. The presence of baseline right bundle branch block correlated with the need for PPI in the TAVI group.

Key Words

aortic stenosis

pacemaker implantation

transcatheter aortic valve implantation

valve replacement

Abbreviations and Acronyms

1-AVB

first-degree atrioventricular block

aortic stenosis

AVB

atrioventricular block

confidence interval

ECG

electrocardiogram/electrocardiographic

IQR

interquartile range

IVCD

intraventricular conduction disturbance

LAH

left anterior hemiblock

LBBB

left bundle branch block

odds ratio

PPI

permanent pacemaker implantation

RBBB

right bundle branch block

SAVR

surgical aortic valve replacement

symptomatic bradycardia

STS

Society of Thoracic Surgeons

TAVI

transcatheter aortic valve implantation

Cited by (0)

: Dr. Rodés-Cabau is a consultant for Edwards Lifesciences, Inc. and St. Jude Medical. Drs. Dumont, Cheung, Ye, Doyle, and Webb are consultants for Edwards Lifesciences, Inc. Drs. Cheung, DeLarochellière, and Webb are consultants for St. Jude Medical. Dr. Velianou is a proctor for Edwards Lifesciences, Inc. Dr. Pibarot has received honoraria for presentations and research grants from Edwards Lifesciences, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.