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Updated: Dec 25, 2025
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Published on: August 8, 2025
Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve
Takahiro Tsushima1, Fahd Nadeem2, Sadeer Al-Kindi2
1Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Insights
This study developed a new risk score to predict the need for cardiac implantable electronic devices after transcatheter aortic valve replacement. The model uses simple pre-operative factors to identify patients at higher risk for this complication.
Area of Science:
- Cardiology
- Medical Devices
- Predictive Modeling
Background:
- High-grade atrioventricular block requiring cardiac implantable electronic device (CIED) implantation is a significant complication after transcatheter aortic valve replacement (TAVR).
- Existing pre-operative factors have limited accuracy in predicting post-TAVR CIED implantation, highlighting the need for a validated risk model.
Purpose of the Study:
- To develop and validate a risk prediction model for high-grade atrioventricular block necessitating CIED implantation post-TAVR.
- To identify simple, pre-operative parameters that can accurately assess this risk.
Main Methods:
- A retrospective analysis of 888 patients undergoing TAVR was conducted, with the cohort split into derivation (n=507) and validation (n=381) groups.
- A logistic regression model identified independent predictors: self-expanding valve, hypertension, pre-existing first-degree atrioventricular block, and right bundle branch block.
- A scoring system was created and validated internally.
Main Results:
- The developed risk score incorporates four key pre-operative variables.
- Internal validation demonstrated good predictive accuracy with an area under the curve of 0.693.
- The model showed an ideal linear relationship in the calibration plot (R² = 0.933).
Conclusions:
- A simple, validated risk prediction model for post-TAVR CIED implantation has been established.
- This model effectively utilizes readily available pre-operative parameters to assess patient risk.
- The developed scoring system aids in predicting the likelihood of requiring a CIED after TAVR.
Objectives:
The aim of this study was to develop and validate a risk prediction model for high-grade atrioventricular block requiring cardiac implantable electronic device (CIED) implantation after transcatheter aortic valve replacement (TAVR).
Background:
High-grade atrioventricular block requiring CIED remains a significant sequelae following TAVR. Although several pre-operative characteristics have been associated with the risk of post-operative CIED implantation, an accurate and validated risk prediction model is not established yet.
Methods:
This was a single center, retrospective study of consecutive patients who underwent TAVR from March 10, 2011, to October 8, 2018. This cohort sample was randomly divided into a derivation cohort (group A) and a validation cohort (group B). A scoring system for risk prediction of post-TAVR CIED implantation was devised using logistic regression estimates in group A and the calibration and validation were done in group B.
Results:
A total of 1,071 patients underwent TAVR during the study period. After excluding pre-existing CIED, a total of 888 cases were analyzed (group A: 507 and group B: 381). Independent predictive variables were as follows: self-expanding valve (1 point), hypertension (1 point), pre-existing first-degree atrioventricular block (1 point), and right bundle branch block (2 points). The resulting score was calculated from the total points. The internal validation in group B showed an ideal linear relationship in calibration plot (R2 = 0.933) and a good predictive accuracy (area under the curve: 0.693; 95% confidence interval: 0.627 to 0.759).
Conclusions:
This prediction model accurately predicts post-operative risk of CIED implantation with simple pre-operative parameters.
