February 23rd, 2011
High Pacemaker Insertion Rate Observed After CoreValve TAVI Implantation
One-third of patients who underwent transcatheter aortic valve implantation with the CoreValve device required a permanent pacemaker within 30 days, according to a report published online in Circulation. Researchers in the UK examined data from 243 patients who received the CoreValve device. The incidence of LBBB was 13% prior to the procedure and 61% afterward.
Patients who had periprocedural atrioventricular block, balloon predilatation, a larger device, interventricular septum diameter, and a prolonged QRS duration were most likely to require a pacemaker.
The rate of pacemaker implantation in patients who have received the Edwards-Sapien valve has been much lower, according to the authors. They speculated that the greater need for pacemakers after implantation of the CoreValve device may be due to “the precise position of the valve within the aortic root,” so that the skirt sits “directly adjacent to the LBB.”
Electrophysiologist Westby Fisher joked on his blog that the requirement for permanent pacemakers could represent a “new annuity” for electrophysiologists.