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26.06.2020 | Original Article | Ausgabe 12/2020

Heart and Vessels 12/2020

Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis

Heart and Vessels > Ausgabe 12/2020
Michal Droppa, Tanja K. Rudolph, Jan Baan, Niels-Erik Nielsen, Helmut Baumgartner, Jeroen Vendrik, Maren Froehlich, Oliver Borst, Jochen Wöhrle, Meinrad Gawaz, Paul Potratz, Luis P. Hack, Victor Mauri, Jacek Baranowski, Peter Bramlage, Jana Kurucova, Martin Thoenes, Wolfgang Rottbauer, Tobias Geisler
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The online version of this article (https://​doi.​org/​10.​1007/​s00380-020-01653-6) contains supplementary material, which is available to authorized users.

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Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01–2.59), QRS duration > 117 ms (OR 2.58; 95% CI 1.73–3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39–7.72), left anterior hemi block (OR 1.92; 95% CI 1.19–3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05–2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19–21.86) and first-degree AVB (OR 2.39; 95% CI 1.18–4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07–4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35–2.59), mean TAVI valve implantation depth below the annulus > 30% (OR 3.75; 95% CI 2.01–6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%; p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes.
Clinical Trial: NCT03497611.

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