Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve. Issue 1 (12th November 2016)

• Record Type: Journal Article
• Authors: Zaman, Sarah; McCormick, Liam; Gooley, Robert; Rashid, Hashrul; Ramkumar, Satish; Jackson, Damon; Hui, Samuel; Meredith, Ian T.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 90:Issue 1(2017)
• Page Start: 147
• Page End: 154
• Publication Date: 2016-11-12
• Subjects: aortic valve disease -- percutaneous intervention -- transcatheter valve implantation -- imaging -- electron beam CT/multidetector CT; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26857
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To determine the incidence and predictors of permanent pacemaker (PPM) requirement following transcatheter aortic valve replacement (TAVR) with the mechanically expanded Lotus TM Valve System (Boston Scientific). Background: Pacemaker implantation is the most common complication following TAVR. Predictors of pacing following TAVR with the Lotus valve have not been systematically assessed. Methods: Consecutive patients with severe aortic stenosis who underwent Lotus valve implantation were prospectively recruited at a single‐centre. Patients with a pre‐existing PPM were excluded. Baseline ECG, echocardiographic and multiple detector computed tomography as well as procedural telemetry and depth of implantation were independently analyzed in a blinded manner. The primary endpoint was 30‐day incidence of pacemaker requirement (PPM implantation or death while pacing‐dependent). Multivariate analysis was performed to identify independent predictors of the primary endpoint. Results: A total of 104 consecutive patients underwent TAVR with the Lotus valve with 9/104 (9%) with a pre‐existing PPM excluded. New or worsened procedural LBBB occurred in 78%. Thirty‐day incidence of the primary pacing endpoint was 28%. The most common indication for PPM implantation was complete heart block (CHB) (69%). Independent predictors of the primary endpoint included pre‐existing RBBB (hazard ratio [HR] 2.8, 95% CI 1.1–7.0; P = 0.032) and depth of implantation below the noncoronary cusp (NCC) (HR 2.4, 95% CI 1.0–5.7; P = 0.045). Conclusions: Almost a third of Lotus valve recipients require pacemaker implantation within 30 days. The presence of pre‐existing RBBB and the depth of prosthesis implantation below the NCC were significant pacing predictors. © 2016 Wiley Periodicals, Inc.