Background:
A low implantation depth of the transcatheter heart valve (THV) prosthesis is a recognized risk factor for postinterventional permanent pacemaker implantation (PPI). However, the impact of a low implantation depth on the rate of late PPI is unknown.
Aims:
Purpose of this study was to assess whether low implantation depth is associated with higher late PPI.
Methods:
We conducted a single-center retrospective study including all patients with TAVI and evaluable fusion imaging of pre- and post-procedural computed tomography angiography (CTA). Implantation depth was assessed within the fused images. Long-term PPI rates were assessed using a standardized follow-up protocol after TAVI.
Results:
A total 325 patients were included in the study. Of these, 30.5% received a self-expanding THV (Evolut R, Medtronic Inc), and 69.5% received a ballon-expandable THV (SAPIEN 3, Edwards Lifescience). Fusion imaging identified a low prosthesis position in 86 patients (26.5%). During a median follow-up duration of 3.5 years, 84 patients (25.8%) required PPI: 70 occurred early, within the first 30 days and 14 occurred late. In both univariate and multivariate Cox regression, a low prosthesis position significantly increased the risk of early PPI (p<0.001). A low prosthesis position also significantly increased the risk for late PPI In patients with BEV (p=0.006) but not in patients with SEV (p=0.3)
Conclusion:
Low prosthesis position after TAVI assessed by fusion imaging is associated with higher rates of early PPI. In patients treated with BEV, low prosthesis position is additionally associated with a higher risk of late PPI beyond 30 days, whereas no such association is observed in patients treated with SEV.
