Recovery of Conduction in Patients Implanted with Permanent Pacemakers Post Transcutaneous Aortic Valve Replacement is Common

Introduction: The necessity for permanent pacemaker implantation(ppi) is a well-recognized complication post transcutaneous aortic valve implantation (TAVI). The incidence of pacemaker implantation post-TAVI varies widely in different series, from 4% to 40% and may not reflect the true incidence of long term permanent conduction defects. We undertook a retrospective survey of the underlying cardiac rhythm as well as the percentage of ventricular pacing in patients implanted with pacemakers post-TAVI to ascertain in which the conduction defects persisted long term.

Methods: The clinical and pacemaker clinic charts of all patients implanted with pacemakers –post-TAVI at the Wolfson Medical Center with long term follow up were reviewed for variables known to be associated with conduction defects post TAVI. At each clinic visit, the percentage of ventricular pacing was noted, pacing was then inhibited and underlying cardiac rhythm recorded.

Results: From 2013 until 2017 191 TAVI procedures were performed at the Wolfson Medical Center, of which 29(15%) underwent ppi. Long term follow up (>100 days) was available for 22. Average age was 82 years, female gender 19 (65%), valve type- Core valve/Sapiens/Lotus 22(75%)/3(10%)/4(13%), Average follow up was 520±412 days (range 9-1603). Only 3 (1.5%) were found at follow up to have underlying rhythm of second degree block or higher.

Conclusions: Although is a common complication post TAVI, persistent high degree AV block at long term follow up is rare. This finding has important ramifications for pacemaker programming post TAVI, and for understanding the pathophysiology of heart block post TAVI.