Permanent Pacing and TAVR | Journal Scan

May 18, 2015
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Authors:
Petronio AS, Sinning JM, Van Mieghem N, et al.
Citation:
Optimal Implantation Depth and Adherence to Guidelines on Permanent Pacing to Improve the Results of Transcatheter Aortic Valve Replacement With the Medtronic CoreValve System: The CoreValve Prospective, International, Post-Market ADVANCE-II Study. JACC Cardiovasc Interv 2015;8:837-846.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with the Medtronic CoreValve System?

Methods:

Patients undergoing TAVR for symptomatic aortic stenosis and treated with the Medtronic CoreValve System were prospectively enrolled after heart team evaluation. The primary endpoint was the 30-day incidence of PPI with Class I/II indications when the Medtronic CoreValve System was implanted at an optimal depth (≤6 mm below the aortic annulus). The timing and resolution of all new-onset conduction disturbances were analyzed.

Results:

A total of 194 patients were treated. The overall rate of PPI for Class I/II indications was 18.2%. An optimal depth was reached in 43.2% of patients, with a nonsignificantly lower incidence of PPI in patients with depths #6 mm, as compared to those with deeper implants (13.3% vs. 21.1%; p = 0.14). In a paired analysis, new-onset left bundle branch block and first-degree atrioventricular block occurred in 45.4% and 39.0% of patients, respectively, and resolved spontaneously within 30 days in 43.2% and 73.9%, respectively. In patients with new PPI, the rate of intrinsic sinus rhythm increased from 25.9% at 7 days to 59.3% at 30 days (p = 0.004).

Conclusions:

The authors concluded that optimal Medtronic CoreValve System deployment and adherence to international guidelines on cardiac pacing are associated with a lower rate of new PPI after TAVR.

Perspective:

This study suggests that optimal deployment with high implant depth as well as strict adherence to international guidelines on the management of conduction disturbances resulted in a lower rate of PPI. Newer-generation devices that are repositionable and recapturable will improve the ability to properly position the device and likely lead to additional reduction in rates of PPI implantation after TAVR. This would be of considerable importance in lower-risk and younger patients undergoing TAVR.

Keywords: Aortic Valve, Aortic Valve Stenosis, Arrhythmias, Cardiac, Atrioventricular Block, Bundle-Branch Block, Incidence, Pacemaker, Artificial, Transcatheter Aortic Valve Replacement


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