“Device Landing Zone” Calcification, Assessed by MSCT, as a Predictive Factor for Pacemaker Implantation After TAVI

Catheter Cardiovasc Interv. 2010; 73(7):847-858

Latsios G, Gerckens U, Buellesfeld L, Mueller R, John D, Yuecel S, Syring J, Sauren B, Grube E

OBJECTIVES: After trans-catheter aortic valve implantation (TAVI), the need for post-interventional pacemaker (PM) implantation can occur in as many as 10%-50% of cases, but it is not yet clear, how this need can be predicted. The aim of this study was to assess the possible predictive factors of post TAVI PM implantation, based on Computed Tomography (CT) measured aortic valve calcification and its distribution.

METHODS: We prospectively analyzed 81 consecutive symptomatic patients with severe AS scheduled for TAVI using the CoreValve prosthesis (Medtronic, Minneapolis, USA). In all patients, a native and contrast-enhanced multi-slice cardiac CT was performed pre-interventionally, estimating calcification load of the native valve cusps and of the adjacent outflow tract (so called “device landing zone” – DLZ) by the Agatston Score (AgS). Objective, computer-evaluated, pre-procedural ECG-analysis was performed with regards to pre-existing conduction abnormalities. Transthoracic echocardiography was performed pre and post TAVI.

RESULTS: TAVI was successful in all cases. PM implantation was deemed necessary in altogether 32 patients, out of 67 without a PM pre-TAVI (32/67, 47%). Various parameters were tested as predictors of post TAVI PM in a multivariate logistic regression analysis model.Female sex (p=0,005) and depressed EF (p=0,023) showed a significant correlation. PM implantation correlated also to the DLZ calcification, as assessed by CT (p=0,004). This model leads to an AUC (area under the ROC -receiver operator characteristics – curve) of 0,83.

CONCLUSION: Calcium amount in the CoreValve DLZ in combination with clinical data could predict the need for post TAVI PM implantation.

PMID: 20506410

4 Responses

  1. Ronen Rubinshtein  on June 6th, 2010

    Interesting data comparing the degree of calcifications on the aortic valve cusps and LV outflow tract (so called “device landing zone”) with the need for pacemaker implantation post TAVI. One should remember that this is also a relevant topic after conventional aortic valve relpacement. Interestingly, the rates of pacemaker implantation in this study are comparable to other “CoreValve” registries, but perhaps higher than some reports with the “Edwards Sapien” valve. Therfore, it is possible that several factors may contribute to the progression of advance AV block post TAVI. Patient-dependent, device-dependent and maybe operator-dependent. Overall, an interesting observation and an important contribution to the understanding of how to increase safety of this increasingly popular procedure.

  2. Paul Schoenhagen  on June 6th, 2010

    See post from 2/16/2010:

    Correlation of Device Landing Zone Calcification and Acute Procedural Success in Patients Undergoing Transcatheter Aortic Valve Implantations With the Self-Expanding CoreValve Prosthesis.
    Daniel John, Lutz Buellesfeld, Seyrani Yuecel, Ralf Mueller, Georg Latsios, Harald Beucher, Ulrich Gerckens, Eberhard Grube.
    J Am Coll Cardiol Intv. 2010; 3(2):233-243.
    PMID: 20170883

  3. Paul Schoenhagen  on June 6th, 2010

    Also check:

    Predictors for new-onset complete heart block after transcatheter aortic valve implantation.
    Bleiziffer S, Ruge H, Hörer J, Hutter A, Geisbüsch S, Brockmann G, Mazzitelli D, Bauernschmitt R, Lange R.
    JACC Cardiovasc Interv. 2010 May;3(5):524-30.
    PMID: 20488409

  4. Paul Schoenhagen  on June 7th, 2010

    Check:

    CoreValve registries impress at one and two years as randomized trial announced; pacemaker use scrutinized.
    HeartWire
    June 1, 2010. Shelley Wood.


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