Insights into permanent pacemaker implantation following TAVR in a real-world cohort

• Published in: PloS one Vol. 13; no. 10; p. e0204503
• Main Authors: Tichelbäcker, Tobias, Bergau, Leonard, Puls, Miriam, Friede, Tim, Mütze, Tobias, Maier, Lars Siegfried, Frey, Norbert, Hasenfuß, Gerd, Zabel, Markus, Jacobshagen, Claudius, Sossalla, Samuel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17-10-2018; Public Library of Science (PLoS)
• Subjects: Aged, 80 and over; Aortic valve stenosis; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Balloon treatment; Biology and Life Sciences; Biomarkers - metabolism; Bradycardia; Cardiac arrhythmia; Cardiology; Cut-off; Dependence; Diagnosis; EKG; Electrocardiography; Engineering and Technology; Female; Fibrillation; Heart; Heart rate; Heart valve replacement; Hospitals; Humans; Implantation; Intensive care; Internal medicine; Length of Stay; Male; Medical statistics; Medicine and Health Sciences; Multiple regression analysis; Pacemaker, Artificial; Parameters; Patients; Physical Sciences; Postoperative Complications - diagnosis; Postoperative Complications - therapy; Prospective Studies; Regression analysis; Research and Analysis Methods; Systematic review; Transcatheter Aortic Valve Replacement; Germany; New Zealand
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0204503

Permanent pacemaker implantation (PPI) following TAVR is a frequent post interventional complication and its management remains controversial.
We sought to elucidate the electrophysiological, procedural, and clinical baseline parameters that are associated with and perhaps predict the need for PPI after TAVR in a heterogeneous-valve-type real-world cohort.
Overall, 494 patients receiving TAVR at our center from April 2009 to August 2015 were screened. ECG analyses and clinical parameters were collected prospectively.
Overall, 401 patients in this all-comers real-world TAVR cohort with a PPI rate of 16% were included. The mean age was 82 years, and the mean duration to PPI was 5.5 days. A large proportion of Edwards SAPIEN valves (81%), DirectFlow, CoreValve, and Portico were implanted. The main indications for PPI were atrioventricular (AV) block III, AV-block Mobitz type II, bradycardic atrial fibrillation and persistent sinus bradycardia. Between groups with and without PPI, significant differences were noted in the prevalence of post TAVR balloon dilatation, resting heart rate, QRS interval, PR interval with a cut-off of >178 ms, left anterior fascicular block and RBBB in univariate analyses. In the subsequent multiple regression analysis, post TAVR balloon dilatation and a PR interval with a cut-off of >178 ms were significant predictors of PPI.
This real-world cohort differs from others in its size and heterogeneous valve selection, and indicates for the first time that patients with post balloon dilatation or prolonged PR interval are at a higher risk for pacemaker dependency after TAVR.