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New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device
Verena Veulemans1, Derk Frank2,3, Hatim Seoudy2,3
1Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.
Cardiovascular Diagnosis and Therapy
|December 31, 2020
Summary
Previous right bundle branch block and a high left ventricular outflow tract eccentricity index predict the need for a permanent pacemaker after TAVR with the 34 mm Evolut R device. Other factors like implantation depth were not predictive.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Transcatheter aortic valve replacement (TAVR) frequently leads to conduction disorders.
- The 34 mm Medtronic Corevalve Evolut R (STHV-34) device is associated with frequent post-procedural conduction issues.
- Predictive factors for permanent pacemaker (PPM) implantation require further investigation for the STHV-34 device.
Purpose of the Study:
- To identify predictive factors for permanent pacemaker (PPM) implantation following TAVR using the 34 mm Medtronic Corevalve Evolut R (STHV-34) device.
- To assess the role of calcification distribution, implantation depth, and membranous septum length (MSL) in predicting PPM need.
Main Methods:
- Dual-center analysis of 130 patients treated with the STHV-34 device.
- Patients stratified into groups requiring PPM (n=30) and those not requiring PPM (n=100).
- Univariate and multivariate analyses performed to identify predictive factors.
Main Results:
- Previous right bundle branch block (RBBB) was a strong predictor of PPM need (OR: 11.52).
- Left ventricular outflow tract eccentricity index (LVOT-EI) >0.3 was also highly predictive (OR: 3.07).
- Implantation depth and MSL showed only moderate correlation with PPM prediction.
Conclusions:
- Previous RBBB and a pronounced LVOT-EI are independent predictors of PPM implantation after STHV-34 TAVR.
- Traditional predictors such as MSL and implantation depth were not found to be significant predictors in this cohort.
- This study provides crucial insights for optimizing patient selection and procedural planning for STHV-34 TAVR.
