Delayed pacemaker requirement after transcatheter aortic valve implantation with a new-generation balloon expandable valve: Should we monitor longer?
OBJECTIVES
To analyze the timing of appearance of conduction abnormalities (CAs) after transcatheter aortic valve implantation (TAVI), to identify predictors of delayed CAs requiring pacemaker (PM) implantation and to provide guidance regarding the duration of telemetry monitoring.


BACKGROUND
How long patients remain at risk of development of CAs requiring PM implantation after TAVI and for how long they should be monitored remains unclear but is crucial when considering early discharge.


METHODS
Development of CAs was studied in 701 consecutive patients treated with Edwards Sapien 3 valves and monitored with telemetry for 7 days in a single center. After excluding valve-in-valve procedures and patients with previous PM, 606 patients remained for analysis. Predictors of CAs requiring PM and the time of onset of CAs were analyzed.


RESULTS
Of 606 patients 76 (12.5%) required a PM after TAVI. CAs requiring PM implantation occurred after 48 h in 22.4% (17 patients) and in 10.5% (8 patients) even after 5 days. Of the patients who developed high grade CAs requiring PM after 48 h, 47.1% had no CAs prior to TAVI, and 23.5% had neither pre-existing CAs nor new-developed CAs within the first 48 h after TAVI.


CONCLUSION
After TAVI using a new-generation balloon-expandable valve, delayed development of CAs requiring PM implantation is not uncommon, even after 5 days. More importantly, 23.5% of patients eventually requiring a delayed PM implantation had still no CAs at 48 h after TAVI in this study. These results question the safety of early discharge and support ECG monitoring for a longer time period. The most optimal way to monitor these patients is yet to be determined.
['De-Torres-Alba|Fernando|F|', 'Kaleschke|Gerrit|G|', 'Vormbrock|Julia|J|', 'Orwat|Stefan|S|', 'Radke|Robert|R|', 'Feurle|Monika|M|', 'Diller|Gerhard-Paul|GP|', 'Reinecke|Holger|H|', 'Baumgartner|Helmut|H|']
D000368:Aged D000369:Aged, 80 and over D004562:Electrocardiography D015716:Electrocardiography, Ambulatory D005260:Female D006350:Heart Valve Prosthesis D017052:Hospital Mortality D006801:Humans D008297:Male D010138:Pacemaker, Artificial D013686:Telemetry D013997:Time Factors D065467:Transcatheter Aortic Valve Replacement D016896:Treatment Outcome
Pacemaker Aortic stenosis Transcatheter aortic valve interventions