Evaluation of DDD pacemaker mode switching in TAVI Patients: does a low ventricular pacing percentage mean it was unnecessary?
J Navarro Manchon, G Rad Garcia, M Izquierdo De Francisco, O Cano Perez, J Navarrete-Navarro, C Arveras Martinez, E Robles Perez, S Huelamo Montoro, N Fernandez Ortiz, J Llau Garcia, V V Soriano Alfonso, M Gil Molina, G Murillo Varona, L Martinez Dolz, J Osca AsensiAbstract
Background
Transcatheter aortic valve implantation (TAVI) may lead to permanent pacemaker (PPM) implantation in 5–20% of patients. While the percentage of ventricular pacing (%VP) has been widely studied, the relationship between AAI–DDD mode switches and atrioventricular block (AVB) remains poorly characterized.
Objective/Purpose
To assess the percentage of VP and the occurrence of AVB-related AAI–DDD mode switches in patients undergoing TAVI who required a PPM.
Methods
We included 62 consecutive TAVI patients requiring PPM implantation. Devices were programmed in AAI–DDD mode using an algorithm to monitor mode switches and their causes. The %VP, type of switch, and their association with baseline clinical and electrophysiological characteristics were analyzed.
Results
Among 62 patients, 55% received a PPM for persistent high degree AVB, 3% for alternating bundle branch block, 34% for new LBB (left bundle brunch) with QRS >150 ms or PR >240 ms, and 8% for PR/QRS prolongation >20 ms from already prolonged baseline values. Figure1. During a follow-up of 96 ± 37 days, %VP was high (≥10%) in 40% of patients, intermediate (1–9%) in 18%, and low (≤1%) in 42%. Significant AAI–DDD switches (2nd, 3rd AVB and pause > 3 seconds) occurred in 86% of patients, more frequently in those with persistent AVB (94%), alternating bundle branch block (100%), than PR/QRS prolongation (80%) and new LBB with QRS >150 ms or PR >240 ms (71%), p=0,119. Predictors of mode switching included hypertension and temporary pacemaker requirement. Hypertension, temporary pacemaker requirement, right bundle branch block and persistent high degree AVB predicted higher %VP.
Conclusion
Although elevated %VP (>10%) was observed in only 40% of patients, up to 86% experienced mode switches, underscoring the importance of evaluating AAI–DDD algorithms beyond %VP alone.Baseline characteristics.Abstract.