Indication for Early and Late Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation

Background: Transcatheter aortic valve implantation (TAVI) is still associated with significant risk of higher grade atrioventricular (AV) block and consecutive permanent pacemaker implantation (PPI). The incidence of postoperative new PPI after TAVI ranges from 9% to 26% as most implantations are realized within shortly after the TAVI procedure. There exists limited information regarding delayed PPI and pacemaker dependency following TAVI.

Methods: Concerning the overall population with n = 3144 patients within 6 years (2016–2022) treated with TAVI for severe aortic valve stenosis n = 359 patients were in need for an early (in-hospital stay) and late (Follow up) postoperative PPI. Preoperative characteristics were balanced between patients with and without the indication for PPI.

Results: The type of prosthesis, self-expandable or balloon-expandable, pre- and postballooning did not have an impact on PPI rates. The cohort of n = 359 patients with a PPI after TAVI was analyzed for early (in-hospital stay) and late (Follow up) PPI with respect for the following characteristics: Type of prosthesis (balloon-expandable vs. self-expandable) and size; Time to PPI; Indication leading to PPI; Pacemaker dependency (threshold of ventricular pacing). From n = 359 patients undergoing PPI after TAVI, 87% were in need for a PPI within the initial in-hospital stay and 13% were treated with a PPI during follow-up (mean time=273 days). The number of implanted self-expandable prostheses within 58% of cases dominated in comparison to balloon-expandable prostheses with 40%. The mean size of self-expandable prostheses was 28 ± 3 mm and of balloon-expandable prostheses 27 ± 2 mm (p < 0.001). Mean time to PPI after TAVI was 1 day in the early cohort and 148 days in the late cohort. Indications for PPI in the early group were as follows: AV-III° 81%, AV-II° 7%, AV-I° +LBBB (left bundle branch block) 4%, BAA (bradyarrhythmia absoluta) 5%, SSS (sick sinus syndrome) 3%. Indications for PPI in the late cohort were: AV-III° 59%, AV-II° 13%, AV-I°+LBBB 7%, BAA 18%, SSS 2%. About 40% of patients showed a permanent ventricular pacing dependency with no differences between early and late PPI.

Conclusion: The type of prosthesis (balloon-expanding or self-expanding) had no impact on early or late PPI. AV-III° was the most common indication (early 81% and late 59%) for PPI. PPI due to BAA increased from 5% in the early group to 18% in the late cohort. Ventricular pacing with a permanent dependency of 40% was comparable between groups. PPI can occur late after TAVI, as when the leading indication may differ from cause of early pacemaker implantation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024