Pacemaker Implantation for Low-Grade Conduction Abnormalities After Balloon-Expandable Transcatheter Aortic Valve Implantation

Introduction

A frequent complication after TAVI are postinterventional conduction abnormalities requiring permanent pacemaker implantation. In this study, we analyzed the characteristics of borderline conduction abnormalities leading to pacemaker implantation and the resulting ventricular pacing amounts.

Methods and Results

All patients who underwent balloon-expandable TAVI between 2014 and 2019 in our tertiary center were analyzed in a retrospective manner. One hundred and sixty-five patients of 1083 TAVI-patients developed postinterventional conduction abnormalities leading to pacemaker implantation. Of these 19 (11.5%) did not represent a clear indication for cardiac pacing according to current European guidelines. Patient characteristics, underlying conduction abnormalities, and the temporal change of ventricular pacing percentages at 24 h and 6 weeks after pacemaker implantation were analyzed.

The dominating borderline conduction abnormalities leading to pacemaker implantation were new-onset persisting bundle-branch-blocks and new first-degree AV-blocks with progression of AV-delay.

While pacemaker implantation was safe and without severe complications in all cases, only 6 of 19 patients had high pacing amounts (95%−100%) after 24 h while 11 patients had low to no pacing amounts (0%−5%). After 6 weeks, 8 patients showed decreasing pacing amounts, no patient had an increasing amount of ventricular pacing and all patients had an intrinsic ventricular rhythm > 30/min.

Conclusion

In our cohort of 1038 TAVI patients, 19 patients underwent PMI for borderline CAs (11.5% of all PMI). Of these, only 2 patients had high pacing amounts after 6 weeks. The risk of complete persisting heart block in these patients is very low. Furthermore, algorithms to reduce ventricular pacing are highly effective to avoid ventricular pacing whenever reasonable.