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Edwards received notification of an evoque in tricuspid position where on follow up with the implanting physicians, it was revealed that overnight (night after the implant), the patient went into second degree heart block with escape rhythm in 48-60bpm range.The patient received a permanent pacemaker with cs lead; however, cs was only intermittently capturing and then the site elected to implant a micra leadless.The patient has been discharged and is in stable condition.
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The following sections were updated/corrected/added: b4, g3, g6, h2, h6 and h11.Additional h6 type of investigation code: labelling review.The complaint for valve interacts with conduction system was confirmed with other empirical evidence via information reported by edwards clinical specialist.No manufacturing non-conformities was found during dhr review.A definite root cause is unable to be determined.Since no edwards defect was identified, corrective or preventative actions are not required.Per the instructions for use (ifu), conduction system disturbance and/or heart block which may require treatment (including permanent pacemaker) are potential adverse events.Heart block and other conduction disturbances are common in patients with underlying cardiovascular disease and can be exacerbated or aggravated with standard intra-operative medications or anesthesia.Such events are related to the patient's underlying condition.Other mechanisms for conduction abnormalities could be related to coronary obstruction due to air embolism, coronary spasm and/or local edema affecting the av node.Conduction disturbances have also been documented during transcatheter cardiac procedures as a result of direct interaction with cardiac anatomy, especially in patients with underlying conduction abnormalities.Other potential causes include trauma by a guidewire or delivery system.
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