Author + information
- Toby Rogers1,
- Athanasios Thomaides1,
- Arie Steinvil2,
- Edward Koifman1,
- Michael Lipinski3,
- M Chadi Alraies1,
- Kyle Buchanan1,
- Petros Okubagzi1,
- Rebecca Torguson4,
- Itsik Ben-Dor3,
- Augusto Pichard4,
- Lowell Satler4 and
- Ron Waksman3
- 1MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washington Hospital center, Washington DC, USA, Washington, District of Columbia, United States
- 3Medstar Washington Hospital Center, Washington, District of Columbia, United States
- 4Washington Hospital Center, Washington, District of Columbia, United States
Permanent pacemaker (PPM) implantation remains the Achilles heel of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR). We previously demonstrated that an electrophysiology study (EPS) avoids PPM in over 70% of patients with conduction abnormality but no definitive indication for pacing after TAVR. The impact of this strategy in patients receiving contemporary valves has not been well studied.
Consecutive patients undergoing TAVR at a single US center between 2013 and 2016 with a contemporary balloon expandable or self-expanding TAVR device were included. PPM implantation rates using this strategy were qualitatively compared with published data from recent multicenter trials.
A total of 257 patients were included in the study. The PPM implantation rate was 12.7% for the self-expanding Medtronic Evolut R and 4.7% for the balloon-expandable Edwards Sapien 3. Table 1 summarizes published PPM implantation rates from recent multicenter trials according to type of TAVR device. EPS guided strategy resulted in substantially lower PPM implantation rates compared with most of the recent multicenter TAVR trials, and similar rates to the next generation self-expanding Medtronic Evolut Pro.
|Washington Hospital Center||4.7%||12.7%||—|
|Evolut Pro US Clinical Study||—||10.0%||—|
Further studies are required to determine whether this observed effect is reproducible, and whether this strategy should be adopted in all patients with conduction abnormality and equivocal pacing indication after TAVR.