Permanent Pacemaker implantation (PP) following Transcatheter Aortic Valve Replacement (TAVR) is associated with increased morbidity and costs. However, PP predictors have been scarcely investigated.
We retrospectively analyzed data from a cohort of symptomatic aortic stenosis patients who underwent TAVR and had 2-dimension echocardiogram derived left ventricular outflow tract (LVOT) diameter available. The exclusion criteria were: prior pacemaker and more than 1 valve implanted. We calculated the index as: [valve size (VS)/LVOT]*100. Receiver-operating curve (ROC) was used to determine the binary cut-off value. Variables were selected from univariate analysis and adjusted in the logistic regression model.
The study cohort consisted of 450 consecutive patients. From those, 17% had a prior PPM and 9 received more than 1 valve. ROC analysis demonstrated the best cut-off value of 129 for VS/LVOT index (sensitivity=71%, specificity=67%) to predict PP (C-Statistic=0.74; figure). VS/LVOT index as a function of PP probability is depicted (figure). The adjusted determinants of PP following TAVR were: atrial fibrillation (odds ratio (OR): 4.8 [95% Confidence Interval [CI]: 1.6-11.3; p<0.01), left bundle branch block (OR: 2.7 [1.0-7.4]; p<0.05) and VS/LVOT of 129 (OR: 3.5 [1.3-9.3]; p<0.01).
A simple and non-invasive index of valve size and the left ventricular outflow tract independently predicts the PP requirement following TAVR with good accuracy. Further validation and incorporation in the clinical practice may improve the valve selection size and decrease the PP incidence.