Long-term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve
Abstract
Objectives
To determine permanent pacemaker (PPM) dependency following transcatheter aortic valve replacement (TAVR) with the Lotus™ valve system (Boston Scientific), and the impact of PPM implantation on long-term morbidity and mortality.
Background
Conduction abnormalities are among the most common complications following TAVR. Limited studies have assessed pacing dependency following TAVR.
Methods
Consecutive patients (n = 166) with severe aortic stenosis who underwent TAVR with the Lotus valve system were prospectively recruited from a single-center. PPMs were implanted according to standard clinical criteria. Patients were followed in-hospital and at 1, 3, 6, and 12 months to determine pacemaker dependency and clinical outcomes.
Results
Fourteen patients with a pre-existing PPM (8%) were excluded with the remaining 152 patients aged 83.6 ± 5.6 years and 46% male. PPMs were implanted 3.8 ± 4 days post-TAVR in 38/152 patients (25%). Indication for PPM was complete heart block in 29 (76%) of patients. At 30-day and one-year follow up, 57% and 38% of patients were pacemaker dependent, respectively. The mean ventricular pacing percentage decreased in the first three months after PPM implantation and remained relatively stable after that.
Conclusion
Only 38% of Lotus recipients who require a PPM following TAVR with the Lotus valve remain pacing dependent at one year.
CONFLICT OF INTERESTS
Dr Robert Gooley has received proctor fees from Boston Scientific. Dr Zaman and Dr Gooley are supported by a Robertson Family Research Cardiologist Fellowship. Dr Zaman is supported by a Monash University Early Career Practitioner Fellowship.
