P1019Validation of a risk score to predict the need for pacemaker implantation after transcatheter aortic valve replacement

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Kiani, S, Kamioka, N, Caughron, H, Dong, A, Patel, H, Lisko, J, Gleason, P, Stewart, J, Grubb, K, Greenbaum, A, Devireddy, C, Guyton, R, Leshnower, B, Babaliaros, V, Hoskins, M
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2019
• Subjects: Pacemaker Therapy
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz747.0610

Abstract Background New conduction abnormalities necessitating pacemaker implantation (PMI) is a common occurrence after TAVR. There is an increased rate of PMI in the those receiving the most contemporary implanted valve, the Edwards Sapien-3 (S3), compared to prior generation balloon expandable valves. We previously described predictors of PMI in a large cohort. Herein we sought to validate these predictors of PMI in a subsequent validation cohort. Methods We evaluated all patients undergoing first time elective TAVR with S3 at our institution (n=326). We developed a risk score based on a predictive model we have previously described. Patients received one point for each of the following: history of syncope, oversizing of the valve >16%, baseline right bundle branch block morphology, and two points for a QRS duration >115 ms. We performed regression analysis of the risk score and need for PMI. We also evaluated the performance of the risk score using ROC analysis. Results Thirty patients (8%) of the total cohort had need for PMI after S3 implantation. Those with PMI had a higher rate of pre-existing infra-nodal conduction system disease – including QRS duration >115ms (57% vs. 20%, p<0.001) and right bundle branch block (RBBB) morphology (47% vs. 10%, p<0.001) - as well as more frequent valve oversizing >15.7% (47% vs. 23%, p<0.01). There was no significant difference in a history of syncope (10% vs. 8%, p=0.72) between groups. The PMI risk score had an area under the curve of 0.753 on ROC analysis. The PMI risk score was significantly associated with PMI (OR 2.37; 95% CI [1.64–3.34], p<0.001). Rate of PMI Stratified by Risk Score Conclusions The PMI risk score was strongly predictive of the need for PMI after implantation of the S3 valve in a large validation cohort. The PMI risk score performed well in sensitivity analysis. This PMI risk score represents a simple tool to help further risk stratify patients being considered for TAVR.