Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement in Patients with Pre-Existing Atrial Fibrillation

Abstract

Introduction High-grade atrioventricular block (AVB) requiring cardiac implantable electronic device (CIED) following transcatheter aortic valve replacement (TAVR) is an important post-procedural complication. Risk prediction models have been developed to identify patients in sinus rhythm at risk for CIED placement following TAVR. Atrial fibrillation (AF) is frequently present in patients referred for TAVR and no risk prediction model has been developed for these patients. This study was undertaken to assess the accuracy of utilizing a previously validated risk prediction model in patients with pre-existing atrial fibrillation (1). Methods and Results This single center, retrospective study analyzed patients with pre-existing AF who underwent TAVR from July 2015 to November 2019. A summative risk prediction score was calculated using a previously described risk prediction model based on the use of a self-expanding valve (1 point), hypertension (1 point), and right bundle branch block on baseline electrocardiogram (2 points), and omitting pre-existing first degree AVB. The model demonstrated good predictive accuracy with an ideal linear regression in calibration plot (R2 = 0.778) and AUC in ROC of 0.652 (95% confidence interval 0.558-0.745). Conclusions Our previously validated risk prediction model accurately predicts the risk of post-TAVR CIED implantation in patients with pre-existing AF.