Predictors of ventricular pacing burden after permanent pacemaker implantation following transcatheter aortic valve replacement. Issue 11 (4th September 2020)

• Record Type: Journal Article
• Authors: Elzeneini, Mohammed; Assaf, Yazan; Aalaei‐Andabili, Seyed Hossein; Mahmoud, Ahmad; Hamburger, Robert; Goel, Ramil; Bavry, Anthony A
• Is Part Of: Clinical cardiology. Volume 43:Issue 11(2020)
• Page Start: 1334
• Page End: 1342
• Publication Date: 2020-09-04
• Subjects: pacemaker dependency -- pacemaker independency -- transcatheter aortic valve replacement; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.23447
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract: Background: In the era of an expanding use of transcatheter aortic valve replacement (TAVR), conduction disturbances and the requirement for permanent pacemaker (PPM) implantation remains a clinical concern. Hypothesis: Using a single‐center experience, we sought to identify predictors of ventricular pacing burden after TAVR in patients who required PPM implantation. Methods: We conducted a retrospective study of 359 consecutive patients with symptomatic severe aortic valve stenosis who underwent TAVR at our institution between September 2013 and July 2019. Thirty patients (8.4%) required a PPM within 30 days after TAVR. Pre and post‐TAVR electrocardiograms, pre‐TAVR echocardiograms and computed tomography (CT), TAVR procedural details and post‐TAVR device interrogation records at 1, 3, and 6 months were reviewed. Results: Mean percentage of ventricular pacing (VP%) at 1, 3, and 6 months was 58%, 59%, and 56% respectively. Using univariate logistic regression analysis, patients who had low VP% < 5% at 6 months were more likely to have a prosthesis/echocardiography‐derived left ventricular outflow tract (LVOT) diameter ratio < 1.3 (OR 7.00, P ‐value .048), prosthesis/CT‐derived aortic annulus diameter ratio < 1.02 (OR 7.11, P ‐value .047), post‐TAVR new‐onset LBBB (OR 16.80, P ‐value .019), time to PPM implantation greater than 2 days post‐TAVR (OR 9.38, P ‐value .026) and pre‐TAVR use of a beta blocker (OR 9.40, P ‐value .026). Conclusions: In patients who required a PPM implantation post‐TAVR, a lower TAVR prosthesis/LVOT or aortic annulus diameter ratio, post‐TAVR new‐onset LBBB and later time of PPM implantation showed a trend toward predicting a low VP% at 6 months.