Figure 4.

Factors increasing the risk of new PPI following TAVR in the Navitor IDE Trial. Baseline conduction disturbances, namely first-degree AV block and RBBB, as well as implant depth, increase the risk of new PPI following TAVR. To prevent deep implantation of the Navitor valve, Abbott has refined the implant technique to attain a target implant depth of 3 mm. Key steps include: 1) predilatation to prepare the annulus for the TAVR procedure; 2) position the inflow edge of the stent frame so it is aligned with the base of the NCC; 3) confirm implant depth in cusp overlap and an alternate view to ensure a target implant depth of 3 mm (recommended per IFU); and 4) withdraw guidewire to a mid-ventricular position and confirm detachment of all three retainer tabs.

Abbreviations: AV, atrioventricular; IFU, instructions for use; MS, membranous septum; NCC, noncoronary cusp; PPI, permanent pacemaker implantation; RBBB, right bundle branch block; TAVR, transcatheter aortic valve replacement.