Predictors of Permanent Pacemaker Implantation in Patients After Transcatheter Aortic Valve Replacement in a Chinese Population

Abstract

Background: Permanent pacemaker (PPM) implantation is the main complication of transcatheter aortic valve replacement (TAVR). Few studies have evaluated the requirement for PPM implantation due to ECG changes following TAVR in a Chinese population.Objective: Our study aimed to evaluate the incidence and predictors of PPM implantation in a cohort of Chinese patients with TAVR.Methods: We retrospectively evaluated 39 consecutive patients with severe native aortic stenosis referred for TAVR with a self-expandable prosthesis, the Venus A valve (Venus MedTech Inc., Hangzhou, China), from 2019 to 2021 at the Heart Center of Affiliated Zhongshan Hospital of Dalian University. Predictors of PPM implantation were identified using logistic regression.Results: In our study, the incidence of PPM implantation was 20.5%. PPM implantation occurs with higher risk in patients with negative creatinine clearance (CrCl), dyslipidemia, high Society of Thoracic Surgeons (STS) Morbimortality scores, and lead I T wave elevation. TAVR induced several cardiac electrical changes such as increased R wave and T wave changes in lead V5. The main independent predictors of PPM implantation were new-onset left bundle branch block (LBBB) (coef: 3.211, 95% CI: 0.899–7.467, p = 0.004) and lead I T wave elevation (coef: 11.081, 95% CI: 1.632–28.083, p = 0.016).Conclusion: New-onset LBBB and lead I T wave elevation were the main independent predictors of PPM implantation in patients undergoing TAVR. Clinical indications such as negative CrCl, dyslipidemia, high STS Morbimortality scores, and an increased T wave elevation before TAVR should be treated with caution to decrease the need for subsequent PPM implantation.

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

“…In a prospective study, Pavlicek et al ( 51 ) reported that postoperative new-onset LBBB (OR: 15.72; 95% CI: 3.05–81.03; p = 0.001) and preoperative bundle-branch block (OR: 11.64; 95% CI: 2.87-47.20; p = 0.001) were independent predictors of high-grade atrioventricular block (HAVB) necessitating PPI after TAVR. Data from a Chinese TAVR cohort indicated that new-onset LBBB ( p = 0.004) and lead I T-wave elevation ( p = 0.016) were the primary predictors of PPI ( 52 ). It was also suggested in some studies that ΔPR (the difference between the postoperative and preoperative PR intervals) was probably an independent predictor of delayed late conduction disorders (≥48 h) after TAVR ( 53 ), with ΔPR > 40 ms linked notably to an increased risk of PPI ( 54 ).…”

Perspective Chapter: Transcatheter Aortic Valve Implantation (TAVI)-Anesthetic Considerations

“…It is of great significance to highlight that the patient should be closely monitored during the procedure for signs of stroke, and the conscious sedation offers a clear advantage on this field. Renal failure is also common after TAVI with contributing factors including preoperative impaired renal function and the amount of contrast used [36]. Additionally, the presence of acute renal injury is a negative prognostic factor in patients undergoing TAVI [5].…”