Need for Pacemaker After SAPIEN 3 Heart Valve
What is the influence of implantation depth and prosthesis oversizing on conduction abnormalities (CA) and permanent pacemaker implantation (PPI) after SAPIEN 3 implantation?
Of 244 patients treated with SAPIEN 3, 208 without a previous pacemaker and 184 without baseline CA were analyzed.
New PPI and new or worsened CA or PPI occurred in 16% and 31%, respectively. Patients requiring PPI had a higher prevalence of atrial fibrillation (44% vs. 24%), complete right bundle branch block (27% vs. 5%), and bradycardia (<60 bpm, 38% vs. 21%). In patients with new CA or PPI, implantation depth was lower (at septal side: 29 ± 8% vs. 25 ± 7%) and rate of oversizing was higher (19% vs. 6%). Independent predictors of new or worsened CA or PPI were implantation depth at septal side, oversizing, and QRS duration.
Implantation depth and prosthesis oversizing were associated with a higher rate of new conduction abnormalities or PPI using the SAPIEN 3.
SAPIEN 3 balloon-expandable prosthesis has been designed with a higher metal frame and an outer skirt in order to avoid paravalvular leakage. The current study highlights the relatively high rate of PPI and new or worsened CAs with this valve. So far, the requirement for a pacemaker post-transcatheter aortic valve replacement (TAVR) has not been shown to affect survival, but it does prolong hospital stay, increase costs, is associated with impaired recovery of left ventricular function, and may have deleterious effect on hemodynamics by introducing pacing-induced dyssynchrony. Future studies should focus on assessing if less deep implantation of the valve and avoidance of extreme oversizing lead to a decrease in the need for a PP and new or worsened CAs while preventing paravalvular leakage.
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