Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement

Tsushima, Takahiro; Nadeem, Fahd; Al‐Kindi, Sadeer G.; Clevenger, Joshua; Bansal, Eric; Wheat, Heather L; Kalra, Ankur; Attizzani, Guilherme F.; Elgudin, Yakov; Markowitz, Alan H.; Costa, Marco A.; Simon, Daniel I.; Arruda, Maurício; Mackall, Judith A.; Thal, Sergio

doi:10.1016/j.jacep.2019.10.020

Cited by 9 publications

(15 citation statements)

References 18 publications

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“…Kiani et al developed a points system to risk‐stratify patients for PPM implantation after undergoing TAVR with the balloon‐expandable Edwards SAPIEN 3 valve 13 . Tsushima et al created a points system including both balloon‐expandable and self‐expanding valves, including 31 (3.5%) pacemakers occurring after hospital discharge 14 . Their study found that a self‐expanding valve, history of hypertension, first degree AV block, and RBBB were predictors of need for PPM but there were no factors specifically associated with need for late PPM.…”

Section: Discussionmentioning

confidence: 99%

“…Several single‐center studies have demonstrated the association of pre‐procedural right bundle branch block (RBBB), use of self‐expanding valves versus balloon‐expandable valves, first‐degree atrioventricular block, and valve oversizing as potential risk factors for HAVB post‐TAVR 3,7,8 . Several groups have developed risk stratification tools to predict risk for HAVB 9‐14 . A recent expert consensus document suggests a management strategy for post‐TAVR conduction changes and timing of PPM implantation although the algorithms are quite complex and mostly driven by expert opinion 15 …”

Section: Introductionmentioning

confidence: 99%

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Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation

Mazzella

Sanders

Yang

et al. 2020

Cathet Cardio Intervent

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Objectives To identify associations with either early or late permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) in order to develop an easily interpretable management algorithm. Background Injury to the conduction system after TAVR occasionally requires PPM. There is limited data on how to identify which patients will require PPM, particularly after discharge from index hospitalization after TAVR. Methods All patients having undergone TAVR at the University of North Carolina through August 2019 were identified and records were manually reviewed. Multivariable analyses were performed to identify associations with post‐TAVR PPM due to high‐degree atrioventricular block (HAVB). Comparisons were made between patients with no PPM (n = 304) and PPM required, stratified into early (during index hospitalization, n = 32) and late (during subsequent hospitalization, n = 11) PPM cohorts. Results Of the 347 patents included for analysis, 43 (12.4%) underwent post‐TAVR PPM. In multivariable regression models, early PPM was associated with baseline bifascicular block (OR: 42.16; p < .001), requiring any pacing on first post‐TAVR electrocardiogram (ECG) (OR: 31.55; p < .001), and valve oversizing >15% (OR: 3.61; p < .05). Late PPM was associated with baseline right bundle branch block (RBBB) (OR 12.62; p < .001) and history of atrial fibrillation/flutter (OR 4.83; p < .05). Conclusions Bifascicular block, any pacing on first post‐TAVR ECG, and >15% valve oversizing are associated with early PPM, while RBBB and history of atrial fibrillation/flutter are associated with late PPM. We suggest a management strategy for post‐TAVR surveillance and management of HAVB.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation

Mazzella

Sanders

Yang

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

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“…Several groups have implemented risk stratification scores to predict PPM implementation, although these scores do not discriminate early from late-onset HAVB. [ 10 , 11 ]…”

Section: Timing Of Heart Blockmentioning

confidence: 99%

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

et al. 2021

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Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.

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“…The development of the risk-prediction model for CIED after TAVR has been previously described (1). In brief, 888 patients were randomly divided into two groups, a derivation cohort and validation cohort (507 and 381 cases, respectively).…”

Section: Summary Of Our Previously Reported Modelmentioning

confidence: 99%

“…Several risk calculators have been developed to identify patients at risk for post-TAVR CIED implantation (1,(11)(12). Kiani et al reported the Emory Risk Score, however this model was only applicable to patients with balloon-expandable valve (Edwards SAPIEN 3), not for those receiving self-expanding prostheses.…”

Section: Introductionmentioning

confidence: 99%

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

Wheat

Tshusima

Kindi

et al. 2020

Preprint

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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.

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Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement

Cited by 9 publications

References 18 publications

Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation

Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

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

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