Author + information
- Javier Lopez-Pais1,
- Juan Francisco Oteo Dominguez1,
- Carlos Arellano Flores1,
- Silvia Vilches-Soria2,
- Jorge Manuel Solano López Morel1,
- Carlos Gustavo Martinez Peredo1,
- Arturo Garcia-Touchard1,
- Jose Antonio Fernandez Diaz2,
- Victor Castro3,
- Jorge Toquero3 and
- Javier Goicolea1
Transaortic valve replacement (TAVR) had been the revolution of last decade in the field of interventional cardiology, but despite the improvements of the technique, the incidence of atrioventricular blockage (AVB) remains as an important inconvenience (around 5 to 20%). There is no data of long term pacemakers (PM) dependency after TAVR neither possible predisposal characteristics. The aim of this study is to analyze long-term stimulation requirements of these patients.
Analytical and observational study developed in a University Hospital. We recorded clinic, interventional and electrophysiological data of all consecutive TAVR performed since 2009. Median follow-up was 15.8 months.
Seventeen of 136 (12.5%) TAVR patients received a PM after the intervention. To settle the indication 23.5% of those patients underwent electrophysiological study (EPS). After a median follow-up of 15.8 months, 50% of patients were dependent of PM. Dependency was higher in patients with basal 1st degree AVB (14.2 vs 83.3%, p 0.029). Dependent patients had longer basal PR interval (180±40.0 vs 285±84.1, p 0.3) and longer PR post-procedure (230.4±21.6 vs 381.5±50.6, p<0.01). With a stimulation frequency under 60 bpm, patients with basal right branch blockage (RBB) had a higher percentage of stimulation (97 vs 27%, p<0.01) and patients who underwent EPS to settle the indication had a tendency to high stimulation (16 vs 53%, p 0.16). There were not statistically significant differences with the rest of ECG abnormalities neither in the proportion of dependency, nor in the rate of stimulation. NTproBNP levels were nor related with PM dependency (1968 vs 1085, p0.3). Regarding surgical risk scores, neither EuroScore (30.9 vs 30.2, p0.9) nor STS (15.1 vs 8.5, p0.4) were related to PM dependency.
In our study, the incidence of need of PM after TAVR was 12.5%. Our study suggests that it may be overtreated due to the fact that only 50% of the patients had pacemaker dependency. The main predictor of dependency was the length of PR and patients with basal RBB had more stimulation. Further research is need in this subject in order to improve daily management of AVB in TAVR patients.