Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation

• Published in: Journal of cardiovascular development and disease 2022-09, Vol.9 (10), p.324
• Main Authors: Pinnacchio, Gaetano, Ruscio, Eleonora, Rocco, Erica, Trani, Carlo, Burzotta, Francesco, Aurigemma, Cristina, Romagnoli, Enrico, Scacciavillani, Roberto, Narducci, Maria Lucia, Bencardino, Gianluigi, Perna, Francesco, Spera, Francesco Raffaele, Comerci, Gianluca, Bisignani, Antonio, Pelargonio, Gemma
• Format: Article
• Language: English
• Subjects: Aortic stenosis; AV conduction abnormalities; AV conduction recovery; AV dysfunction after TAVI; Cardiac arrhythmia; Heart rate; Medical imaging; Pacemakers; Patients; permanent pacemaker implantation; Prostheses; Questioning; TAVI; Tomography
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd9100324

Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4−6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.