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Predictors of Early and Late Atrioventricular Block Requiring Permanent Pacemaker Implantation After Transcatheter
Muhammad Zubair Khan1, Ashwani Gupta2, Sona Franklin1
1Department of Medicine, St. Mary Medical Center, Langhorne, PA, USA.
Insights
Transcatheter aortic valve replacement (TAVR) can lead to pacemaker (PM) implantation. Right bundle branch block predicts early PM, while atrial fibrillation and left bundle branch block predict late PM after TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Complete heart block necessitating permanent pacemaker (PM) implantation can occur early after transcatheter aortic valve replacement (TAVR).
- Limited data exist on predictors for late PM implantation following TAVR.
- This study investigates factors influencing early versus late PM implantation post-TAVR.
Purpose of the Study:
- To identify predictors for early (<7 days) versus late (>7 days to 1 year) permanent pacemaker implantation after transcatheter aortic valve replacement.
- To compare baseline characteristics of patients requiring early versus late PM implantation.
Main Methods:
- A cohort of 362 TAVR patients was analyzed.
- Patients were divided into two groups: those requiring PM within 7 days and those requiring PM between 7 days and 1 year post-TAVR.
- Chi-square and multivariate regression analyses were employed to determine predictors.
Main Results:
- 10.4% of TAVR patients (39/362) received a PM; 4.6% early and 5.8% late.
- Right bundle branch block (RBBB) predicted early PM (OR 6.721, p < 0.005).
- Left bundle branch block (LBBB) and atrial fibrillation (AF) predicted late PM (OR 3.5, p < 0.05 for both). Early and late PM groups had longer hospital stays. Heart failure incidence was higher in the late PM group.
Conclusions:
- Permanent pacemaker implantation occurs in 10.4% of TAVR patients, with a significant proportion needing it later than 7 days.
- RBBB is a key predictor for early PM, while AF and LBBB are predictors for late PM post-TAVR.
- Identifying these predictors can aid in risk stratification and management of conduction abnormalities after TAVR.
Purpose:
Complete heart block requiring permanent pacemaker can occur early following transcatheter aortic valve replacement (TAVR) due to mechanical compression of the aortic valve annulus and associated atrio-ventricular (AV) conduction system. Data are limited regarding late PM implantation after TAVR. The purpose of this study was to determine predictors of early vs. late PM implantation post-TAVR procedure.
Methods:
Baseline characteristics of patients who required PM <7 days following TAVR were compared with patients who required a PM >7 days to 1 year following TAVR using Chi-Square and multivariate regression analysis.
Results:
There were 362 TAVR patients, of which 39 (10.4%) received a PM after TAVR. Of these 18 (4.6%) patients required PM within 7 days after TAVR, and 21 (5.8%) required PM after 7 days and up to 1 year later. Right bundle branch block (RBBB) (OR 6.721, CI 2.3-36.9, p < 0.005) was a positive predictor of early PM placement. Left bundle branch block (LBBB) (OR = 3.5, CI 1.19-10.80, p-value < 0.05) and atrial fibrillation (AF) (OR = 3.5, 1.36-9.4 p < 0.05) were predictors for late PM. Early and late PM were associated with a longer median hospital stay compared to no PM (4.9 ± 4.86 days vs. 10.1 ± 10.04 days vs. 6.10 ± 6.02 days). The incidence of heart failure was higher in the late PM group. The overall motility was not increased in early and late PM compared to no PM.
Conclusion:
Patients requiring PM implant after TAVR was 10.4%, of which 5.8% need PM >7 days post-TAVR. RBBB is a predictor for early PM. AF and LBBB were predictors for late PM.
