Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation

Purpose. Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with longer life expectancies. The need for permanent pacemaker implantation (PPI) following TAVI has been associated with increased all-cause mortality and morbidity. This study aimed to identify ECG, CT, and procedural predictors of PPI following TAVI. Methods. We conducted a retrospective observational study at the University Hospital of North Norway. Patients who underwent TAVI with SAPIEN 3 or SAPIEN 3 Ultra valves were included, while those with prior pacemakers, self-expanding valves, or valve-in-valve procedures were excluded. Data were collected from medical records, pre-operative CT scans, and procedural angiography. Results. A total of 416 low- to intermediate-risk patients with a median age of 82 years were included. Of these, 64 patients (15.4%) required PPI within ≤30 days following the index procedure. Multivariable regression analysis identified the following predictors for PPI: pre-existing right bundle branch block (odds ratio (OR), 10.7; 95% CI, 4.74-24.3), first-degree atrioventricular block (OR, 2.62; 95% CI, 1.08-6.32), membranous septum length (OR, 0.77; 95% CI, 0.65-0.90), left ventricular outflow tract calcification (OR, 2.18; 95% CI, 1.12-4.27), and the use of 29 mm valves (OR, 2.33; 95% CI, 1.09-4.97). Conclusions. Our study found the following predictors of PPI following TAVI: pre-existing right bundle branch block, first-degree atrioventricular block, the use of 29 mm valves and the presence of left ventricular outflow tract calcification. Additionally, a short MS was found to increase the chance of PPI; therefore, MS measurements should be included in pre-operative assessments to identify at-risk patients.