Novel Method for Implantation of Balloon Expandable Transcatheter Aortic Valve Replacement to Reduce Pacemaker Rate—Line of Lucency Method

Native aortic leaflets and permanent pacemaker implantation risk following balloon-expandable transcatheter aortic valve implantation

“… 4 , 21 , 22 Okuno et al have demonstrated that PPI incidence following balloon-expandable TAVI was similar in patients with NCC dominant LVOT calcification (16.8%), non-NCC dominant LVOT calcification (15.0%) and no LVOT calcification (14.6%). 22 A very high device implantation technique has been shown to be associated with reduced PPI risk, 23 , 24 but an important concern with such an approach is feasibility of coronary artery access after TAVI. 25 , 26 …”

Effect of Membranous Septal Length on the Risk of Atrioventricular Block in Patients Undergoing Transcatheter Aortic Valve Implantation

“…It has been reported that an MS length <5 mm (in this case, 3.1 mm) is a risk factor for pacemaker implantation. 1 In the high implantation technique, the line of lucency (Figure A, black line) is aligned to the bottom of the noncoronary cusp, not the center marker, which may minimize the risk of pacemaker implantation. 1…”

“…1 In the high implantation technique, the line of lucency (Figure A, black line) is aligned to the bottom of the noncoronary cusp, not the center marker, which may minimize the risk of pacemaker implantation. 1…”

Is Aiming High Always Best?

“…Early experience is promising with no new permanent pacemakers in a small series of patients, which included those with preexisting conduction abnormalities. 3 Further validation will be required in a multicentre experience and a broader anatomical subset of patients. This technique may be beneficial in selected cases such as those at high risk of developing a new conduction disorder, and may reduce the rate of new PPM.…”