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Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation for aortic stenosis using Medtronic new generation self-expanding CoreValve Evolut R

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Abstract

Conduction disturbance requiring permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve implantation (TAVI) using Medtronic self-expanding CoreValve, and has remained common following the introduction of the new generation CoreValve Evolut R device. The aim of this study was to identify the determinants of PPM implantation after TAVI with CoreValve Evolut R. We retrospectively examined 114 patients who underwent transfemoral TAVI using CoreValve Evolut R. We excluded 17 patients with preprocedural PPM, 1 patient requiring Edwards SAPIEN 3 implantation after CoreValve Evolut R implantation, and 4 patients who died during the hospital admission. Thus, 92 patients were finally included in the analysis. Seventeen patients (18%) underwent new PPM implantation after TAVI. Preprocedural electrocardiography showed a lower ventricular rate and more right bundle branch block (RBBB) in patients with new PPM implantation compared to those without. Quantitative multidetector computed tomography assessment revealed larger aortic valve calcification (AVC) and higher asymmetry (∆AVC) in patients with new PPM implantation compared to those without. The univariate logistic regression analysis demonstrated that preprocedural ventricular rate ≤ 70 beats per minute, RBBB, AVC ≥ 110 mm3, and ∆AVC ≥ 45 mm3 were associated with new PPM implantation. Number of these factors clearly stratified the risk of new PPM implantation. In conclusion, PPM implantation occurs in 18% of patients undergoing TAVI with the new generation CoreValve Evolut R. Lower preprocedural ventricular rate, RBBB, larger AVC, and higher ∆AVC are associated with new PPM implantation after TAVI using the new generation CoreValve Evolut R.

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Acknowledgements

We thank all staff of the intervention laboratory in our institute.

Funding

This work was supported by the Japan Society for the Promotion of Science (Hidehiro Kaneko).

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  1. Hidehiro Kaneko and Frank Hoelschermann contributed equally to this publication (share the first authorship).

Authors and Affiliations

  1. Heart Center Brandenburg in Bernau and Brandenburg Medical School, Ladeburger Straße 17, 16321, Bernau, Germany

    Hidehiro Kaneko, Frank Hoelschermann, Martin Seifert, Grit Tambor, Maki Okamoto, Viviane Moeller, Michael Neuss & Christian Butter

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  1. Hidehiro Kaneko
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Correspondence to Christian Butter.

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Kaneko, H., Hoelschermann, F., Seifert, M. et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation for aortic stenosis using Medtronic new generation self-expanding CoreValve Evolut R. Heart Vessels 34, 360–367 (2019). https://doi.org/10.1007/s00380-018-1236-z

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