Abstract
In a meta-analysis by Siontis et al (J Am Coll Cardiol 2014;64:129, PMID 25011716), the authors investigated the prevalence and predictors of atrioventricular (AV) conduction disturbance requiring permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR). On combining data from 41 studies that included >11,000 patients with severe aortic stenosis who underwent TAVR with either the Edwards SAPIEN valve or the Medtronic CoreValve delivered via a variety of approaches, they found that the overall rate of pacemaker implantation was 17%, with a median of 6% for those receiving the Edwards SAPIEN valve and 28% for those receiving the Medtronic CoreValve. In addition, they abstracted data from the studies and found that a number of factors predicted the need for pacemaker after TAVR, including male gender, baseline (preintervention) conduction disturbances (first-degree AV block, right bundle branch block, and left anterior hemiblock), and intraprocedural AV block. The authors conclude that this information can be useful to identify high-risk patients undergoing TAVR and may help guide clinical decision making before and after the procedure.
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