Long-Term Pacemaker Dependency Following Implantation with the LOTUS Transcatheter Aortic Valve

Objectives: To determine permanent pacemaker (PPM) dependency following Transcatheter Aortic Valve Replacement (TAVR) with the LotusTM valve system (Boston Scientific), and the impact of PPM implantation on long-term morbidity and mortality. Background: Conduction abnormalities are the most common complication 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-centre. 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: 14 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 1-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. Conclusions: Only 38% of Lotus recipients who require a PPM following TAVR with the Lotus valve remained pacing dependent at one year.