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Predictors for permanent pacemaker implantation following transcatheter aortic valve implantation: trends over the past decade

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Abstract

Purpose

This study sought to identify risk factors for permanent pacemaker implantation (PPMI) after Transcatheter aortic valve implantation (TAVI) and explain their trends over the last decade. TAVI is performed nowadays for severe aortic stenosis in more patients with lower surgical risk. While most TAVI complications have been reduced, PPMI remains common.

Methods

In this observational, retrospective cohort analysis, 338 TAVI patients treated between 2008 and 2017 were reviewed. Risk factors were compared between the early (2008–2013) and late years (2014–2017), and a multivariable logistic regression model was used.

Results

A decreasing trend in PPMI over time was observed (p for trend = 0.008), as was a lower rate of PPMI in the late period (19.3% vs. 31.7%, p = 0.009). Three variables were identified as independent risk factors for PPMI that also decreased significantly in the late period: valve implantation depth ≥ 8 mm (OR = 4.3, 95% CI 2.3–8.2, p < 0.001), use of self-expandable valves (OR = 2.8, 95% CI 1.4–5.5, p = 0.004), and patient risk assessed by EuroSCORE II (OR = 1.07, 95% CI 1.0–1.1, p = 0.034). Indications for PPMI were also shown to change over time, with an increase in the prevalence of complete AVB as the main indication for PPMI (p = 0.048), and a trend towards a decrease in LBBB alone (p = 0.061).

Conclusions

The decrease in post-TAVI PPMI over the past decade is multifactorial and can be explained by (1) lower baseline patient surgical risk, (2) modified procedural variables including decreased implantation depth and increased use of balloon-expandable valves, and (3) refined indications for PPMI.

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Abbreviations

AVR:

Aortic valve replacement

AVB:

Atrioventricular block

COPD:

Chronic obstructive pulmonary disease

EF:

Ejection fraction

LAHB:

Left anterior hemiblock

LBBB:

Left bundle branch block

LVOT:

Left ventricular outlet tract

NYHA:

New York Heart Association

PPMI:

Permanent pacemaker implantation

RBBB:

Right bundle branch block

STS:

Society of Thoracic Surgeons

TAVI:

Transcatheter aortic valve implantation

VARC2:

Valve Academic Research Consortium-2

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Authors and Affiliations

  1. Cardiology Department, Hadassah University Hospital, Jerusalem, Israel

    Rotem Eliav, Yair Elitzur, David Planer, Ronen Beeri, Dan Gilon, Mony Shuvy, David Luria, Haim Danenberg & Gidon Y. Perlman

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  1. Rotem Eliav
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  2. Yair Elitzur
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  3. David Planer
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  4. Ronen Beeri
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  5. Dan Gilon
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  7. David Luria
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  8. Haim Danenberg
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  9. Gidon Y. Perlman
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Contributions

Rotem Eliav: conceptualization, methodology, writing—original draft; Yair Elitzur: investigation; David Planer: investigation; Ronen Beeri: investigation; Dan Gilon: investigation; Mony Shuvy: investigation; David Luria: investigation; Haim Danenberg: investigation, writing—review and editing; Gidon Y. Perlman: conceptualization, supervision, investigation, writing—review and editing.

Corresponding author

Correspondence to Gidon Y. Perlman.

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The authors declare that they have no conflicts of interest.

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All patients gave written informed consent for treatment and data collection, and the study was approved by the Hadassah Medical Center Institutional Review Board. The procedures used in this study adhere to the tenets of the declaration of Helsinki.

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Informed consent was obtained from all induvial participants included in the study.

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Informed consent was obtained from all induvial participants included in the study.

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Eliav, R., Elitzur, Y., Planer, D. et al. Predictors for permanent pacemaker implantation following transcatheter aortic valve implantation: trends over the past decade. J Interv Card Electrophysiol 62, 299–307 (2021). https://doi.org/10.1007/s10840-020-00902-y

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