C-46 | Novel Predictors and Clinical Outcomes of Permanent Pacemaker Placement (PPM) Following Transcatheter Aortic Valve Replacement (TAVR): A Midwest Rural Center Experience

Pacemaker post transcatheter aortic valve replacement: A multifactorial risk?

“…In conclusion, pacemaker post-TAVR is related to multifactorial risk. Nwaedozie et al [ 9 ] brought to the body of evidence ECG and clinical findings, but procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate. Long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.…”

“…In the present issue of the Journal, Nwaedozie et al [ 9 ] assessed the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR permanent pacemaker need and also reported the impact of permanent pacemaker implantation on clinical outcomes at one year. In this regard, they retrospectively analyzed the single-center cohort of a tertiary hospital in central Wisconsin, United States involving 357 patients who underwent a TAVR (95.2% of transfemoral approach) between January 2012 and December 2019 using balloon-expandable and self-expanding THV in 53.8% and 46.2%, respectively.…”

“…Their pacemaker rates are similar to the Medtronic self-expanding THV in the Evolut Low-Risk trial (17.4% at 30 d and 19.4% at one year) and slightly above what we could expect with the Edwards SAPIEN 3 balloon-expandable valve (PARTNER 3 trial: 6.6% at 30 d and 7.5% at one year)[ 10 , 11 ]. The median time of implantation in the study by Nwaedozie et al [ 9 ] was 2 d, and half of the patients underwent pacemaker implantation within 48 h post-TAVR. Complete atrioventricular block was the predominant indication (66.7%) and the other indications were as follows: left ventricle dysfunction (10.5%), symptomatic bradycardia (8.8%), and symptomatic second atrioventricular block (1.8%).…”

“…Importantly, Nwaedozie et al [ 9 ] did not report data on the procedural depth of THV implantation which is a major predictor of the need for a permanent pacemaker post-TAVR. To emphasize the role of the implantation technique and volume-outcome relationship, in a sub-analysis of the Evolut low-risk trial, there was a substantial variation in the rate of permanent pacemaker implantation from site to site in this study including 699 patients from 84 centers, with a lower rate of pacemaker need in high volume centers[ 3 , 16 ].…”

Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!

“…In a retrospective cohort study published in the journal by Nwaedozie et al [ 8 ], patients undergoing TAVR between 2012 and 2019, were followed for 1 year. The effect of baseline DM, supraventricular arrhythmia, and pre-existing nonspecific interventricular conduction delay (QRS duration > 120 ms without any right BBB or left BBB morphology) on the incidence of PPM implantation post-TAVR was analyzed[ 8 ]. The study included 357 patients with a mean age of 80 years.…”