Predictors of pacemaker implantation after TAVI in a registry including self, balloon and mechanical expandable valves.

Abstract

The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve implantation (TAVI). The aim of our study was to evaluate different anatomical, clinical, electrocardiographic, and procedural variables associated with the development of conduction abnormalities after TAVI across the entire device spectrum. Single-center prospective cohort of consecutive patients who underwent TAVI since March 2017. Final cohort was studied to detect areas of calcium within aortic valve characterized by leaflet sector and region. Membranous septum (MS) length was assessed throughout a modified coronal view. Device selection and positioning were performed according to the operator criteria. Device selection and positioning were performed according to the operator criteria. From the 273 patients included, 57 underwent PPMI (20.8%). Univariate analysis determined right bundle branch block (RBBB), QRS duration, MS length and calcium within LVOT of non-coronary cuspid as independent predictors. After multivariable logistic regression, both RBBB (OR 6.138; 95% CI 1.23-30.73, P = 0.027) and MS length (OR 0.259; 95% CI 0.164-0.399, P < 0.005) emerged as statistically significant. As a model, they could predict PPMI in 88.7%, independently of which valve used. Youden index analysis yielded 7.69 mm as the optimal cut-off with a negative and positive predictive value of 94.7 and 71.9%, respectively. In our experience, both RBBB pattern and short membranous septum (< 8 mm) were strongly and independently associated with new permanent pacemaker implantation, regardless of the device type. Our findings suggest that this simple evolved measure of MS length may guide device selection and implantation technique and facilitate early discharge.

• Authors: Francisco Gama, Pedro de Araújo Gonçalves, João Abecasis, António Miguel Ferreira, Pedro Freitas, Mariana Gonçalves, Salomé Carvalho, Afonso Félix Oliveira, Henrique Mesquita Gabriel, João Brito, Luís Raposo, Pedro Adragão, Manuel de Sousa Almeida, Rui Campante Teles
• Journal: The international journal of cardiovascular imaging (Int J Cardiovasc Imaging) Vol. 38 Issue 1 Pg. 225-235 (Jan 2022) ISSN: 1875-8312 [Electronic] United States
• PMID: 34390445 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Nature B.V.

Topics

• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Heart Valve Prosthesis
• Humans
• Pacemaker, Artificial
• Predictive Value of Tests
• Prospective Studies
• Registries
• Retrospective Studies
• Risk Factors
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome