Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

Abstract

Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.

Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019

“…Patients undergoing TAVI with left bundle‐branch block, right bundle‐branch block, and second‐degree heart block were more likely to be discharged on the second and third day following TAVI compared with SDD; likely because of a need for further rhythm monitoring for potential PPM implantation during the index admission. Prior studies demonstrated a higher rate of PPM implantation in patients undergoing TAVI with a preexisting bundle‐branch block 27 , 28 , 29 and may represent a cohort of patients where SDD may not be feasible.…”

Evolving Devices and Material in Transcatheter Aortic Valve Replacement: What to Use and for Whom

“…Complete heart block requiring PPI within 30 days still occurs in around 10–15% of patients undergoing TAVR, even with newer generation devices. Despite notable advances in THV design and procedural technique, the rates of post-TAVR conduction disturbances have not significantly decreased over time, ranging from 4.0% to 24.0% with the Sapien 3 and from 14.7% to 26.7% with the Evolut R [ 68 ], even in the most recent years [ 69 , 70 ].…”

Predictors of postoperative negative outcomes in patients undergoing transcatheter aortic valve implantation

“…Identify statistically and clinically significant factors associated with poor surgical outcomes and contextualise these factors within clinical practice. Jiang, 2021, Ullah, 2021, Van Mourik, 2020and Li, 2021 The inclusion criteria for all four reviews were similar. Only studies which included patients who underwent TAVI and reported clinical outcomes such as hospital readmission, all-cause mortality, incidence of prosthetic valve endocarditis or incidence of pacemaker implantation were included (Jiang et al, 2021;Ullah et al, 2021;Li et al, 2021;Van Mourik et al, 2020).…”

“…Jiang, 2021, Ullah, 2021, Van Mourik, 2020and Li, 2021 The inclusion criteria for all four reviews were similar. Only studies which included patients who underwent TAVI and reported clinical outcomes such as hospital readmission, all-cause mortality, incidence of prosthetic valve endocarditis or incidence of pacemaker implantation were included (Jiang et al, 2021;Ullah et al, 2021;Li et al, 2021;Van Mourik et al, 2020). The four reviews all included randomised control trials (RCTs), with three reviews also including observational studies (Jiang et al, 2021;Ullah et al, 2021;Li et al, 2021).…”