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Valvular heart disease
Original research
Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI
  1. Nynke H M Kooistra1,
  2. Martijn S van Mourik2,
  3. Ramón Rodríguez-Olivares3,
  4. Alexander H Maass4,
  5. Vincent J Nijenhuis5,
  6. Rik van der Werf4,
  7. Jurrien M ten Berg5,
  8. Adriaan O Kraaijeveld1,
  9. Jan Baan Jr2,
  10. Michiel Voskuil1,
  11. M Marije Vis2,
  12. Pieter R Stella1
  1. 1 Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
  3. 3 Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain
  4. 4 Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
  5. 5 Department of Cardiology, St Antonius hospital, Nieuwegein, Utrecht, The Netherlands
  1. Correspondence to Dr Pieter R Stella; P.Stella{at}umcutrecht.nl

Abstract

Background The timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.

Methods and results We performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.

Conclusions Safe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.

  • valvular heart disease
  • aortic stenosis
  • transcatheter valve interventions

https://doi.org/10.1136/heartjnl-2019-315967

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    Footnotes

    • NHMK and MSvM contributed equally.

    • Contributors NHMK, MVM, MiV, MaV and PRS contributed to the conception and design of the work, analysis and interpretation of the findings and drafting and critical revision of the work. RR-0, AHM, VN, HW, JB, AOK and JtB contributed to data collection and critical revision of the work. All authors have read and approved the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PRS was a member of the Keystone Heart advisory board.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available for sharing. The data, analytic methods, and study materials will be made available to other researchers for approved funded reasonable requests to reproduce the results.