Gaede L, et al. - This paper incorporated an inquiry of the predictors of atrioventricular block III° (AVBIII) persistence with concurrent permanent pacemaker (PPM) dependency after transcatheter aortic valve implantation (TAVI). The findings revealed a low long-term persistence of AVBIII after TAVI. The recommendation put forth was to postpone the indication for PPM implantation for a couple of days. The only predictors of a lack of recovery of the AVB were found to be prior right bundle branch block (RBBB), higher mean aortic valve gradients and postdilatation of the prosthesis.

Methods

• 1198 patients underwent TAVI at the Kerckhoff Heart and Thorax Center, Germany, between 2010 and 2015.
• The exclusion criteria included patients with prior PPM (n=173).
• 14.7% (n=176) of the patients underwent PPM implantation after the procedure.
• Independent predictors of PPM implantation were pre-existing right bundle branch block (RBBB, p < 0.001) and implantation of a CoreValve prosthesis (p < 0.001).
• Follow-up was done for a median of 73 (IQR 62-85) days, in the subgroup of patients with a newly implanted PPM (n = 102).

Results

• The leading indication for PPM implantation was AVBIII in 74.5% (76/102).
• 22.4% (17/76) of the enrollees reported persistent AVBIII at follow-up.
• Prior RBBB (p = 0.04), postdilatation (p = 0.006) and higher mean aortic valve gradient prior to implantation (p = 0.013), were the predictors of AVBIII persistence.
• Herein, the PPMs were implanted earlier in patients with persisting AVBIII [1 day (IQR0-2.5) vs. 4 days (IQR2-7); p < 0.001].
• The only independent predictor of persistent AVBIII [OR 1.36 (95% 1.05-1.75); p = 0.02] was disclosed to be the early PPM implantation after TAVI.