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

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.

Download Full-text

INCIDENCE OF PERMANENT PACEMAKER IMPLANTATIONS AND NEW-ONSET INTRAVENTRICULAR CONDUCTION ABNORMALITIES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A COMPARISON OF THE NOVEL SAPIEN 3 WITH THE SAPIEN XT PROSTHESIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)62005-8 ◽

2015 ◽

Vol 65 (10) ◽

pp. A2005

Author(s):

Oliver Husser ◽

Thorsten Kessler ◽

Christof Burgdorf ◽

Markus Kasel ◽

Adnan Kastrati ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Permanent Pacemaker ◽

The Novel ◽

Intraventricular Conduction ◽

Transcatheter Aortic Valve ◽

Sapien 3 ◽

New Onset

Download Full-text

Incidence and Predictors of Permanent Pacemaker Implantation in Patients Who Underwent Transcatheter Aortic Valve Replacement: Observation of a Chinese Population

Cardiology ◽

10.1159/000502792 ◽

2019 ◽

Vol 145 (1) ◽

pp. 27-34 ◽

Cited By ~ 1

Author(s):

Fang Du ◽

Qifeng Zhu ◽

Jubo Jiang ◽

Han Chen ◽

Xianbao Liu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Chinese Population ◽

Transcatheter Aortic Valve Replacement ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Multivariable Logistic Regression Analysis ◽

Transcatheter Aortic Valve ◽

Implantation Depth

Aims: Permanent pacemaker (PPM) implantation is one of the most common complications after transcatheter aortic valve replacement (TAVR). We studied the incidence of PPM implantation and identified the predictors in patients who underwent TAVR in a Chinese population. Methods and Results: A total of 256 patients who underwent TAVR with self-expandable valves were included. The incidence of PPM implantation in our study population was 14.8%. In patients who received PPM implantation, the proportion of bicuspid aortic valve (BAV) patients was much lower compared to tricuspid aortic valve (TAV) patients (18.4 vs. 81.6%, p < 0.05). Patients with BAV were associated with a significantly lower PPM implantation rate and shallower implantation depth compared to patients with TAV (6.4 vs. 21.7% and 4.2 ± 4.4 vs. 6.2 ± 5.0 mm, respectively, p < 0.05 for both). In the multivariable logistic regression analysis, prior right bundle branch block (RBBB; OR 8.3, 95% CI 2.2–32.1, p < 0.05), implantation depth (OR 1.3, 95% CI 1.1–1.5, p = 0.01), and TAV (OR 4.7, 95% CI 1.5–14.4, p < 0.05) were independent predictors of PPM implantation after TAVR. There was no difference in 30-day and 1-year all-cause mortality between the 2 groups. Conclusions: The incidence of PPM implantation in patients with self-expandable valves after TAVR was 14.8% in our cohort study. Independent predictors of PPM implantation included prior RBBB, TAV, and implantation depth at the noncoronary sinus side. TAVR in BAV with a supra-annular structure-based sizing strategy might decrease the risk of PPM implantation.

Download Full-text