Characteristics of and current practice patterns of pacing for high‐degree atrioventricular block after transcatheter aortic valve implantation in comparison to surgical aortic valve replacement

Abstract

Objective We aimed to investigate the current practice patterns of permanent pacing, especially the timing of implantation, for high‐degree AV block (HDAVB) following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Background Comparative data regarding current practice patterns of permanent pacing for HDAVB between TAVI and SAVR is limited. Methods Using the National Inpatient Sample database, we identified patients who underwent TAVI or SAVR between 2012 and 2014. The incidence of HDAVB, the rate of permanent pacemaker implantation, and the timing of implantations were compared between TAVI and SAVR groups. Results We identified 33 690 and 202 110 patients who underwent TAVI and SAVR, respectively. HDAVB occurred in 3480 patients (10.3%) in the TAVI group and 11 405 patients (5.6%) in the SAVR group (P < 0.001). Among the patients who developed HDAVB, patients in the TAVI group were more likely to undergo permanent pacemaker implantation than those in the SAVR group (74.1% vs 64.7%; P < 0.001). The median interval from TAVI to pacemaker implantation was 2 days (interquartile range 1‐3 days) vs 5 days (interquartile range 3‐7 days) from SAVR to pacemaker implantation (P < 0.001). Among the patients who developed HDAVB, TAVI was associated with higher rates of permanent pacemaker implantation after adjusting for other comorbidities (odds ratio 1.41:95% confidence interval 1.13‐1.77; P = 0.003). Conclusions HDAVB occurred more commonly after TAVI compared to SAVR. HDAVB after TAVI compared to SAVR was associated with a higher rate of permanent pacemaker implantation at an earlier timing from the index procedure.

Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement

“…In the present study, PPI was performed after a median duration of 6 (3.0–7.0) days. Compared with SAVR, PPI lasted fewer days after TAVR (median 13 days), consistent with another study [15] . Shorter PPI duration after TAVR was attributed to the greater impact of conduction disorders on hemodynamic recovery after TAVR since most TAVR patients were older with higher comorbidities compared with SAVR patients.…”

“…Compared with SAVR, PPI lasted fewer days after TAVR (median 13 days), consistent with another study. [ 15 ] Shorter PPI duration after TAVR was attributed to the greater impact of conduction disorders on hemodynamic recovery after TAVR since most TAVR patients were older with higher comorbidities compared with SAVR patients. Thus, acute management with temporary pacing was indicated in most cases.…”

Baseline CT-Based Risk Factors for Atrioventricular Block after Surgical AVR

“…As time evolves, complications in surgical aortic valve replacement (SAVR) and sutureless aortic valve replacement (suAVR) have been reduced. Still, the postoperative atrioventricular block III (AVBIII) remains a noteworthy problem: A postprocedural third degree atrioventricular block occurs in 5.6% of the patients receiving a SAVR [1] while up to 16 % of the patients undergoing suAVR suffer an AVB III. [2][3][4] The implantation of a permanent pacemaker occurs in 3.6% and up to 23 % of the patients respectively.…”

“…The MIS lies near the AV and merges into the interleaflet fibrous triangle between the right coronary cusp (RCC) and the noncoronary cusp (NCC) (►Fig. 1). Apart from separating the left and right ventricles, it contains the atrioventricular conduction axis and runs as bundle of His close to the surface of the LVOT.…”

Incidence and Predictors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Procedures: Data of The Netherlands Heart Registration (NHR)

“…Due to the proximity of the atrioventricular conduction system to the aortic valve structures, any intervention, either transcatheter or surgical at the valve level, may result in atrioventricular (AV) conduction system disturbances that can lead to permanent PM implantation [3]. The inherent features of the TAVI-related valve structure and deployment, however, make such an adverse event more frequent after transcatheter than surgical procedures, where post-operative PM rate reaches from 2 to 6% [4]. To some extent, the predictive factors of post-TAVI PM have been studied in the TAVI population, including pre-procedural right bundle branch block or left bundle branch block, use of self-expanding bioprosthesis, and valve implantation depth [3,5].…”