Right ventricle pacing may undermine the benefits of transcatheter aortic-valve replacement (TAVI), according to a new study.

Researchers at the University of Bonn (Germany) conducted a prospective study involving 86 consecutive patients between 2008 and 2010 (38 male; mean age 80), with severe symptomatic aortic-valve stenosis and indication for TAVI. Of these, 29 Patients (34%) had already had a pacemaker placed before TAVI, or needed one due to post-interventional AV-Block III. The study was designed to evaluate the effects of right ventricular pacing on left ventricular function after TAVI; follow up was after six months with echocardiography.

The results showed that left ventricular Tei-Index (LC-Tei) and systolic pulmonal-artery pressure, as well as left ventricular mass index and right ventricular indices, did not differ before TAVI in both groups. However, six months after TAVI left ventricular ejection fraction increased significantly in the group without permanent pacemaker, and was significantly different to the ejection fraction of the pacemaker group six months after TAVI. Systolic pulmonary artery pressure (sPAP), as well as LV-Tei were different between both groups after six months, but failed to show statistical significance. Left ventricular mass index and right ventricular indices did not differ before and six months after TAVI in both groups. The study was presented at EuroEcho 2011, held during December 2011 in Budapest (Hungary).

“If they need a pacemaker, they need it; and if they do not get the TAVI, they would probably die within one or two years. They need both,” said lead author and study presenter Marcel Weber, MD, and colleagues of the department of cardiology. “We have to watch the ejection fraction; if they don't get a better ejection fraction three months after TAVI then we have to consider a different device, a cardiac resynchronization device.”

TAVI involves the percutaneous insertion of a catheter containing a replacement valve at a site in the groin or the left chest. The new valve is pushed into the correct site, where the surgeon expands it and pushes the old one aside. The procedure is much less invasive than traditional open heart aortic valve replacement and does not require putting the patient on a heart and lung machine, so it can be performed on those who cannot have open heart surgery. In addition, data from recent trials suggest that this procedure might also be a viable option for patients who qualify for open-heart surgery, but who are considered high-risk surgical candidates.

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