Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with severe aortic stenosis. Despite newer generation valves, atrioventricular (AV) conduction disturbance is a common complication, necessitating permanent pacemaker (PPM) implantation in about 10% of patients. Hence, it is imperative to improve periprocedural risk stratification to predict PPM implantation after TAVR. The objective of this study was to externally validate a novel risk-stratification model derived from the National Inpatient Sample (NIS) database that predicts risk of PPM from TAVR. Methods:Components of the score included pre-TAVR left and right bundle branch block, sinus bradycardia, second-degree AV block, and transfemoral approach. The scoring system was applied to 917 patients undergoing TAVR at our institution from November 2011 to February 2017. We assessed its predictive accuracy by looking at two components: discrimination using the C-statistic and calibration using the Hosmer-Lemeshow goodness of fit test.Results: Ninety patients (9.8%) required PPM. The scoring system showed good discrimination with C-statistic score of 0.6743 (95% CI: 0.618-0.729). Higher scores suggested increased PPM risk, that is, 7.3% with score ≤3, 19.23% with score 4-6, and 37.50% with score ≥7. Patients requiring PPM were older (81.4 versus 78.7 years, P = .002). Length of stay and in-hospital mortality was significantly higher in PPM group. Conclusions:The NIS database derived PPM risk prediction model was successfully validated in our database with acceptable discriminative and gradation capacity. It is a simple but valuable tool for patient counseling pre-TAVR and in identifying high-risk patients. K E Y W O R D Selectrocardiogram, electrophysiology -basic, electrophysiology -clinical, pacing

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

“…Table 1 shows the baseline characteristics of the included studies. The 36 studies included a total of 55,851 patients in the final analysis, from 2005 to 2018 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. The mean age of the patients was 81.9 years, with a mean STS score of 8.3.…”

Novel Method for Implantation of Balloon Expandable Transcatheter Aortic Valve Replacement to Reduce Pacemaker Rate—Line of Lucency Method

“…The existing literature suggests that despite improvements in valve design over multiple generations, permanent pacemaker implantation (PPMI) is required in 9-15% of cases following TAVR, a significantly higher risk than in patients undergoing SAVR. [21][22][23] Importantly, implantation of a permanent pacemaker following TAVR is associated with longer hospital and intensive care unit (ICU) stays, increased overall cost, risk of heart failure, and rehospitalization. 24,25 Independent predictors of PPMI in previous reports have included preexisting conduction abnormalities, implant depth, and need for repositioning of self-expanding implants.…”

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

“…Shivamurthy et al recently published a study of external validation of their risk prediction model for post-TAVR CIED placement originally developed from the National Inpatient Sample (NIS) database (12,24). This model, primarily composed of baseline ECG features, includes both sinus bradycardia with or without LBBB.…”