Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019;15(3):205-218.
doi: 10.2174/1573403X15666181205105821.

Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status

Eleonora Russo  1   2 , Domenico R Potenza  2 , Michela Casella  3 , Raimondo Massaro  2 , Giulio Russo  4 , Maurizio Braccio  1 , Antonio Dello Russo  3 , Mauro Cassese  1
Affiliations
Review

Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status

Eleonora Russo et al. Curr Cardiol Rev. 2019.

Abstract

Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients. However since the aortic valve has close spatial proximity to the conduction system, conduction anomalies are frequently observed in TAVI. In this article, we aim to review the key aspects of pathophysiology, current incidence, predictors and clinical association of conduction anomalies following TAVI.

Keywords: Transcatheter aortic valve implantation; electrophysiological study; left bundle branch block; pacemaker implantation; predictive factors; review; valve in valve transcatheter aortic valve implantation..

PubMed Disclaimer

Figures

Fig. (1)
Fig. (1)
Anatomic relationship between the aortic valve and the atrioventricular conduction system. The left bundle branch exits below the base of the interleaflet triangle separating the noncoronary and right coronary leaflets of the aortic valve and descends along the septal surface of the left ventricular myocardium (although there is an interindividual variation in the location of the proximal portion of left bundle). During TAVI procedure, conduction anomalies are primarily related to a mechanical trauma. In the figure is represented a self expanding device which is delivered into the LVOT and this may result in more injury to the AV node and left bundle branches. Furthermore, the damage may be delayed because of the self expanding nature of the prosthesis and tissue edema.
Fig. (2)
Fig. (2)
Permanent PM rates with different devices.
See this image and copyright information in PMC

References

    1. Smith C.R., Leon M.B., Mack M.J., et al. PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011;364(23):2187–2198. - PubMed
    1. Nishimura R.A., Otto C.M., Bonow R.O., et al. AHA/ACC 2017 Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2017;70(2):252–289. - PubMed
    1. De Torres-Alba F., Kaleschke G., Diller G.P., et al. Changes in the pacemaker rate after transition from edwards sapien xt to sapien 3 transcatheter aortic valve implantation: The critical role of valve implantation height. JACC Cardiovasc. Interv. 2016;9(8):805–813. - PubMed
    1. Husser O., Pellegrini C., Kessler T., et al. Predictors of permanent pacemaker implantations and new-onset conduction abnormalities with the SAPIEN 3 balloon-expandable transcatheter heart valve. JACC Cardiovasc. Interv. 2016;9(3):244–254. - PubMed
    1. Webb J.G., Wood D.A., Ye J., et al. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves. Circulation. 2010;121(16):1848–1857. - PubMed

SUPPLEMENTAL REFERENCES

    1. De Carlo M., Giannini C., Bedogni F., et al. Safety of a conservative strategy of permanent pacemaker implantation after transcatheter aortic CoreValve implantation. Am. Heart J. 2012;163(3):492–499. - PubMed
    1. Ledwoch J., Franke J., Gerckens U., et al. German Transcatheter Aortic Valve Interventions Registry Investigators. Incidence and predictors of permanent pacemaker implantation following transcatheter aortic valve implantation: Analysis from the German transcatheter aortic valve interventions registry. Catheter. Cardiovasc. Interv. 2013;82(4):E569–E577. - PubMed
    1. Lange P., Greif M., Vogel A., et al. Reduction of pacemaker implantation rates after CoreValve implantation by moderate predilatation. EuroIntervention. 2014;9(10):1151–1157. - PubMed
    1. Mouillet G., Lellouche N., Yamamoto M., et al. Outcomes following pacemaker implantation after transcatheter aortic valve implantation with CoreValve(®) devices: Results from the FRANCE 2 Registry. Catheter. Cardiovasc. Interv. 2015;86(3):E158–E166. - PubMed
    1. Nazif T.M., Dizon J.M., Hahn R.T., et al. PARTNER Publications Office. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: The PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc. Interv. 2015;8(1 Pt A):60–69. - PubMed

MeSH terms