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A Combined Electrocardiographic and Imaging Predictive Risk Model for New Permanent Pacemaker After Transcatheter
Giulia Costa1, Marco Angelillis1, Cristina Giannini1
1CardiacThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Abstract:
Currently, permanent pacemaker implantation (PPMI) is the most common complication of transcatheter aortic valve implantation (TAVI). The aim of this analysis is to develop a simple and effective risk prediction model for PPMI within 30 days of TAVI. Data from 370 patients who underwent TAVI with the self-expanding valve between February 2015 and June 2022 at our center were collected in the development cohort (DC). A risk score was developed based on baseline anatomical and electrocardiographic characteristics, including the estimation of aortic calcium load (ACL) using both the Agatston score and calcium volume. A validation cohort (VC) of 234 patients was used to test the score. Seventy-two patients (19.5%) underwent PPMI in DC. Preprocedural right bundle branch block (RBBB), membranous septum length (MSL) <5 mm, and severe ACL were significant predictors of PPMI. The Agatston score showed higher agreement with PPMI compared to calcium volume (K = 0.89; 95% CI 0.84 to 0.93 vs K = 0.71; 95% CI 0.64 to 0.79, respectively). Pre-existing RBBB, MSL, and Agatston score have been combined into a simple score, called RITMO (theoretical range from -1 to 4 points). We applied the score to the VC and find that a high score (>1) had an OR>6 to predict PPMI after TAVI. In patients undergoing TAVI with a self-expanding valve, baseline RBBB, shorter MSL, and higher ACL evaluated using the Agatston method were predictive of 30-day PPMI. In conclusion, the RITMO score represents a simple tool for risk stratification, with implications for procedural planning and patient counseling.
Insights
Permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI) is common. The RITMO score, using baseline RBBB, short septum length, and aortic calcium, effectively predicts 30-day PPMI risk in TAVI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Permanent pacemaker implantation (PPMI) is the most frequent complication following transcatheter aortic valve implantation (TAVI).
- Accurate risk stratification for PPMI is crucial for procedural planning and patient counseling.
- Existing models may not fully capture the anatomical and electrocardiographic factors influencing PPMI post-TAVI.
Purpose of the Study:
- To develop and validate a simple, effective risk prediction model for 30-day PPMI after TAVI using a self-expanding valve.
- To identify key baseline predictors of PPMI, including anatomical and electrocardiographic characteristics.
- To integrate these predictors into a novel risk score for clinical utility.
Main Methods:
- A retrospective analysis of 370 patients undergoing TAVI with a self-expanding valve (development cohort).
- Development of a risk score based on preprocedural right bundle branch block (RBBB), membranous septum length (MSL), and aortic calcium load (ACL) assessed by Agatston score.
- Validation of the score in an independent cohort of 234 patients.
Main Results:
- 19.5% of patients in the development cohort required PPMI.
- Preprocedural RBBB, MSL <5 mm, and severe ACL (Agatston score) were significant predictors of PPMI.
- The RITMO score demonstrated high predictive accuracy in the validation cohort, with a high score (>1) indicating an odds ratio >6 for PPMI.
Conclusions:
- The RITMO score, incorporating RBBB, MSL, and Agatston-assessed ACL, is a simple and effective tool for predicting 30-day PPMI after TAVI with self-expanding valves.
- This score aids in stratifying patient risk, informing procedural decisions, and enhancing pre-procedural patient communication.
- The Agatston score for ACL demonstrated superior agreement with PPMI compared to calcium volume.
