Author + information
- Giuseppe Lanzillo1,
- Letizia Bertoldi2,
- Claudio Montalto3,
- Matteo Pagnesi3,
- Richard Jabbour4,
- Satoru Mitomo5,
- Francesco Giannini6,
- Damiano Regazzoli6,
- Marco Ancona6,
- Matteo Montorfano3,
- Alaide Chieffo6 and
- Antonio Colombo7
- 1San Raffaele Scientific Institute, Milan, Italy., Milano, Milan, Italy
- 2San Raffaele Scientific Institute, Milano, Milan, Italy
- 3San Raffaele Scientific Institute, Milan, Milan, Italy
- 4Imperial College London, London, United Kingdom
- 5IRCCS San Raffaele Scientific Institute, Milan, Milan, Italy
- 6Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 7Interventional Cardiology Institute San Raffaele Hospital - Stamford Hospital - Columbia University - Centro Cuore Columbus, Milan, Milan, Italy
Elective pacemaker (PMK) implantation is a routine procedure with a relatively low rate of complications. PMK is not rarely required after transcatheter aortic valve implantation (TAVI) but data are lacking about the rate of PMK-related complications in this population.
Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single center in Milan (Italy), between October 2007 and July 2015.
The overall population included 737 patients. 123 patients (16.6%) underwent PMK implantation. Three of them were excluded from the final analysis because PMK was implanted after discharge in other hospitals. The final population consisted of 120 patients (16.3%). A high rate of major bleeding events (n=40; 33.3%) was observed in the PMK population. In 18 patients (15%) a pocket hematoma was found; in other cases (n=22; 18.3%) the source of bleeding was not found. Compared to patients not implanted with a PMK, major bleeding events were higher in patients receiving a PMK (33.3 vs 22.4%; p=0.01). The rate of major bleeding was higher if the PMK was implanted within the first 24 hours after TAVI (43.6 vs 24.6%, p=0.02). In patients with major bleeding, 5 patients (12.5%) did not take any antiplatelet/anticoagulant drugs; 11 patients (27.5%) were on single antiplatelet, 20 patients (50%) on dual antiplatelet and one patient (2.5%) was on antiplatelet and anticoagulant. In 2 patients (1.6%) an infection of the PMK pocket occurred. In 3 (2.5%) PMK implantation was complicated by cardiac tamponade: 2 (1.6%) required percutaneous drainage, while one (0.8%) required surgical drainage. 3 patients (2.5%) had lead malfunction. One patient (0.8%) had a pneumothorax successfully treated with intercostal tube drainage. One patient (0.83%) had a thrombosis of the left brachiocephalic vein that required an anticoagulation therapy. One patient (0.83%) had a dissection of the left internal mammary artery and haemothorax, which led to patient death.
PMK-related complications are not uncommon in TAVI and some of these can be potentially lethal. Particular attention is required in the periprocedural management of these patients.