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Open Access Research article

Predictive factors for pacemaker requirement after transcatheter aortic valve implantation

Ibrahim Akin1*, Stephan Kische1, Lylia Paranskaya1, Henrik Schneider1, Tim C Rehders1, Ulrich Trautwein1, Gökmen Turan1, Dietmar Bänsch1, Olga Thiele1, Dimitar Divchev1, Ilkay Bozdag-Turan1, Jasmin Ortak1, Gunther Kundt2, Christoph A Nienaber1 and Hüseyin Ince1

Author affiliations

1 Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, Rostock, 18057, Germany

2 Institute for Biostatistics and Information in Medicine and Ageing Research, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, Rostock, 18057, Germany

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Citation and License

BMC Cardiovascular Disorders 2012, 12:87  doi:10.1186/1471-2261-12-87

Published: 4 October 2012

Abstract

Background

Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI.

Methods

Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done.

Results

TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p<0.001), longer AH (153.6±43.4 msec versus 116.1±31.2 msec; p<0.001) and HV interval (81.7±17.8 msec versus 56.8±8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay.

Conclusion

Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.

Keywords:
TAVI; AV block; Left bundle branch block; Pacemaker; His bundle