Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation for aortic stenosis using Medtronic new generation self-expanding CoreValve Evolut R

Abstract

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.

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

“…A total of 31 261 patients undergoing TAVR from 78 studies were included, of these 6212 (19.8%) received PPM, while 25 049 (80.2%) did not require a PPM. 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

Transcatheter aortic valve replacement: Past, present, and future

“…Self‐expanding valves are traditionally associated with a greater risk of conductive abnormalities when compared to its balloon‐expandable counterpart 84,119,120 . The reported incidence of PPM implantation post‐TAVR has ranged between 5% and 10% for the Edwards SAPIEN balloon‐expandable valves and approximately 25% for the self‐expanding Medtronic CoreValve 40,121 . However, the more recent SAPIEN 3 valve has been reported by some to exhibit higher rates of PPM dependency when compared to its predecessors.…”

“… 84 , 119 , 120 The reported incidence of PPM implantation post‐TAVR has ranged between 5% and 10% for the Edwards SAPIEN balloon‐expandable valves and approximately 25% for the self‐expanding Medtronic CoreValve. 40 , 121 However, the more recent SAPIEN 3 valve has been reported by some to exhibit higher rates of PPM dependency when compared to its predecessors. Despite reducing the risk of paravalvular aortic regurgitation, the design addition of an outer sealing skirt (Figure 2 ) likely increases the radial force exerted on surrounding cardiac tissue and predisposes patients to atrioventricular conductive disturbances.…”

Quantification of Aortic Valve Calcification in Contrast-Enhanced Computed Tomography

“…The presence of aortic valve calcification alone is associated with a significantly higher risk for cardiovascular and coronary events [1,4]. A combination of elevated aortic valve calcium content and a pre-existing complete right bundle branch block has led to a higher risk for pacemaker implantation according to several authors [5,[21][22][23]. Total aortic valve calcification has been implicated for a higher risk of paravalvular leakage after intervention [24][25][26][27].…”