Pacemaker memory in post-TAVI patients: Who should benefit from permanent pacemaker implantation?

BACKGROUND: One of the most frequent complications of transcatheter aortic valve implantation (TAVI) is the occurrence of atrioventricular (AV) conduction disorders secondary to AV node or His bundle injury leading to permanent pacemaker implantation (PPI). The objective was to quantify the rate of ventricular pacing (VP), according to post-TAVI indication for PPI using recorded pacemaker memory.

METHODS: From October 2009 to January 2017' all patients who had PPI following TAVI performed at Rouen University Hospital were included. Indications for PPI were: ≥ 1 episode of complete atrioventricular block (CAVB) or 2:1 atrioventricular block, and new-onset persistent left bundle branch block (NOP-LBBB) with either prolonged PR interval (> 200 ms) or HV interval (>70 ms). The primary endpoint was VP percentage at the first pacemaker interrogation (a VP percentage ≥ 1% was considered as significant).

RESULTS: Out of 936 TAVI patients (Sapien-3' n = 379 [Edwards Lifesciences, Irvine, CA, USA]; Sapien-XT' n = 513; CoreValve' n = 44, Medtronic, Minneapolis, MN, USA), 87 (9.3%) had PPI. Eighty of these 87 patients were followed-up and analyzed. At the first pacemaker interrogation, a significant VP percentage was observed in 60/80 followed-up patients (75%), in 46/51 patients (90.2%) implanted for CAVB, and 12/23 patients (52.2%) implanted for NOP-LBBB associated with either prolonged PR or HV interval. No clinical predictive factor of significant VP percentage was found.

CONCLUSION: In the post-TAVI period, our data support PPI in patients with CAVB even if paroxysmal. Our data also suggest PPI may be considered in patients with NOP-LBBB associated with either prolonged PR or HV interval.