Anatomical Predictors of Pacemaker Dependency After Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Conduction disturbances are a known complication following transcatheter aortic valve replacement (TAVR).
• Limited data exist on anatomical predictors of pacemaker dependency post-TAVR.
• This study aimed to identify factors influencing pacemaker dependency after TAVR.

Purpose of the Study:

• To determine the rate of pacemaker dependency after TAVR.
• To identify anatomical and procedural predictors of pacemaker dependency.
• To assess the impact of pacemaker dependency on long-term survival.

Main Methods:

• A cohort of patients requiring pacemaker implantation within 30 days of TAVR was analyzed.
• Baseline ECG, CT scans, and procedural data, including valve implantation depth and membranous septum length, were collected.
• Pacemaker dependency at 30 days and 1 year, and all-cause mortality were evaluated.

Main Results:

• Of 112 patients needing pacemakers post-TAVR, 44.6% were dependent at 30 days and 46.7% at 1 year.
• Predictors of 30-day pacemaker dependency included LVOT calcifications (OR 5.69) and ΔMSID ≥3 mm (OR 7.58).
• Membranous septum length and implantation depth alone were not significant predictors. Pacemaker dependency did not impact survival.

Conclusions:

• Less than half of patients requiring pacemakers after TAVR are dependent long-term.
• Left ventricular outflow tract calcifications and ΔMSID ≥3 mm predict pacemaker dependency.
• These findings can guide device selection and programming strategies post-TAVR.