Flexible LV pacing configurations are a useful feature of CRT systems for preventing PNS. The optimal LV pacing configuration should be determined on the basis of individual patient testing.

Redo CRT implantation after device extraction owing to device-related infection has a low success rate and shows a higher rate of re-infection than that observed in patients who undergo CRT implantation for the first time. Further, patients whose blood cultures are positive for S. aureus show a particularly poor outcome.

Conduction disturbance requiring permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve implantation (TAVI) using Medtronic self-expanding CoreValve, and has remained common following the introduction of the new generation CoreValve Evolut R device. The aim of this study was to identify the determinants of PPM implantation after TAVI with CoreValve Evolut R. We retrospectively examined 114 patients who underwent transfemoral TAVI using CoreValve Evolut R. We excluded 17 patients with preprocedural PPM, 1 patient requiring Edwards SAPIEN 3 implantation after CoreValve Evolut R implantation, and 4 patients who died during the hospital admission. Thus, 92 patients were finally included in the analysis. Seventeen patients (18%) underwent new PPM implantation after TAVI. Preprocedural electrocardiography showed a lower ventricular rate and more right bundle branch block (RBBB) in patients with new PPM implantation compared to those without. Quantitative multidetector computed tomography assessment revealed larger aortic valve calcification (AVC) and higher asymmetry (∆AVC) in patients with new PPM implantation compared to those without. The univariate logistic regression analysis demonstrated that preprocedural ventricular rate ≤ 70 beats per minute, RBBB, AVC ≥ 110 mm, and ∆AVC ≥ 45 mm were associated with new PPM implantation. Number of these factors clearly stratified the risk of new PPM implantation. In conclusion, PPM implantation occurs in 18% of patients undergoing TAVI with the new generation CoreValve Evolut R. Lower preprocedural ventricular rate, RBBB, larger AVC, and higher ∆AVC are associated with new PPM implantation after TAVI using the new generation CoreValve Evolut R.

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