Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation

• Published in: Catheterization and cardiovascular interventions Vol. 97; no. 4; pp. E588 - E596
• Main Authors: Mazzella, Anthony J., Sanders, Mason, Yang, Hannan, Li, Quefeng, Vavalle, John P., Gehi, Anil
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.03.2021; Wiley Subscription Services, Inc
• Subjects: Aortic valve; atrial fibrillation; Cardiac arrhythmia; EKG; Electrocardiography; Fibrillation; Heart; heart block; Hospitalization; pacemaker; Pacemakers; Regression analysis; transcatheter aortic valve replacement; heart block; transcatheter aortic valve replacement; atrial fibrillation; pacemaker
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29239

Objectives To identify associations with either early or late permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) in order to develop an easily interpretable management algorithm. Background Injury to the conduction system after TAVR occasionally requires PPM. There is limited data on how to identify which patients will require PPM, particularly after discharge from index hospitalization after TAVR. Methods All patients having undergone TAVR at the University of North Carolina through August 2019 were identified and records were manually reviewed. Multivariable analyses were performed to identify associations with post‐TAVR PPM due to high‐degree atrioventricular block (HAVB). Comparisons were made between patients with no PPM (n = 304) and PPM required, stratified into early (during index hospitalization, n = 32) and late (during subsequent hospitalization, n = 11) PPM cohorts. Results Of the 347 patents included for analysis, 43 (12.4%) underwent post‐TAVR PPM. In multivariable regression models, early PPM was associated with baseline bifascicular block (OR: 42.16; p < .001), requiring any pacing on first post‐TAVR electrocardiogram (ECG) (OR: 31.55; p < .001), and valve oversizing >15% (OR: 3.61; p < .05). Late PPM was associated with baseline right bundle branch block (RBBB) (OR 12.62; p < .001) and history of atrial fibrillation/flutter (OR 4.83; p < .05). Conclusions Bifascicular block, any pacing on first post‐TAVR ECG, and >15% valve oversizing are associated with early PPM, while RBBB and history of atrial fibrillation/flutter are associated with late PPM. We suggest a management strategy for post‐TAVR surveillance and management of HAVB.