Predictors of permanent pacemaker implantation after TAVI with Navitor transcatheter heart valve

This study aimed to identify predictors of permanent pacemaker implantation (PPI) within 30 days after transcatheter aortic valve implantation (TAVI) using the Navitor™ (Abbott Chicago, IL, USA) transcatheter heart valve (THV).

This retrospective two-center study included 173 patients with severe aortic stenosis undergoing transfemoral TAVI with Navitor™ THV. Patients with prior pacemaker implantation and valve-in-valve procedures were excluded. Mean age was 81.5 ± 5.0 years, and 54 patients (31 %) required PPI; they were more often male (57 % vs. 37 %, p = 0.01), had higher left ventricular ejection fraction (55.3 ± 9.0 vs. 52.4 ± 9.2, p = 0.049), and higher rates of COPD (30 % vs. 16 %, p = 0.017) and pre-existing right bundle branch block (RBBB; 17 % vs. 0.8 %, p < 0.001). Procedural factors associated with PPI included greater annulus-to-THV oversizing (13.6 % ± 3.4 vs. 12.5 % ± 3.1, p = 0.041), implantation depth > 4 mm (75.9 % vs. 52.1 %, p = 0.002), and 29 mm valve size use (46.3 % vs. 26.9 %, p = 0.010). At multivariable analysis, COPD (OR 2.4, p = 0.049), pre-existing RBBB (OR 34.4, p = 0.001), annulus-to-THV oversizing (OR 1.2, p = 0.002), and implantation depth > 4 mm (OR 3.2, p = 0.007) were independent predictors of PPI. ROC analysis (AUC 0.58) identified an optimal cut-off of 15 % annulus-to-THV oversizing for predicting PPI.

Annulus-to-THV oversizing emerges as a novel independent predictor for PPI after TAVI with Navitor™ THV.