# Avoiding Pacemaker Implantation by Using Intracardiac Echocardiography During Self-Expanding Valve TAVR

## TL;DR

Using intracardiac echocardiography during TAVR can help avoid pacemaker implantation by assessing valve placement relative to the heart's conduction system.

## Contribution

Demonstrates how intracardiac echocardiography can guide TAVR to prevent conduction disturbances and avoid pacemaker implantation.

## Key findings

- Intracardiac echocardiography showed valve calcifications prevent contact with the conduction system.
- Deep valve implantation without pacemaker implantation was possible due to calcifications at specific cusps.
- Computed tomography and echocardiography together can assess risk for conduction disturbances.

## Abstract

Intracardiac echocardiography during transcatheter aortic valve replacement (TAVR) clarifies the relationship between the bioprosthetic valve and membranous septum (MS), reducing atrioventricular conduction disturbances.

An 82-year-old man with severe aortic stenosis underwent transfemoral TAVR owing to annular calcification; we used a self-expanding 29-mm Evolut FX valve (Medtronic) for the procedure. Computed tomography showed a short MS length, indicating high risk for conduction disturbance. Intracardiac echocardiography revealed that although the valve extended beyond the MS, calcifications at the noncoronary cusp (NCC) and right coronary cusp (RCC) would prevent contact with the muscular septum, avoiding the need for permanent pacemaker implantation (PPI).

The conduction pathway and the MS are located between the NCC and RCC. Severe calcification at these sites may reduce the risk of PPI.

Significant valve calcification at the NCC and RCC may allow deep implantation during TAVR without PPI.