A Two-Step Risk Score for Prediction of Permanent Pacemaker Implantation After Transcatheter Aortic Valve...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Postoperative permanent pacemaker implantation (PPMI) is a frequent complication following transcatheter aortic valve implantation (TAVI).
• Existing risk assessment tools may not reflect current TAVI prosthesis generations.
• A need exists for improved prediction of PPMI after TAVI.

Purpose of the Study:

• To develop and validate a novel, two-step risk score for predicting PPMI after TAVI.
• To implement the risk score into a user-friendly website for clinical application.
• To address data gaps concerning current TAVI devices and patient profiles.

Main Methods:

• Retrospective analysis of 1039 patients undergoing TAVI between January 2019 and December 2020.
• Development of a prediction model using 55 patient and procedural characteristics from 836 eligible patients.
• Identification of 14 preprocedural risk factors for PPMI, incorporated into the TAVI PACER score's first step.

Main Results:

• 17.8% (149/836) of patients required PPMI within 30 days post-TAVI.
• Key preprocedural risk factors identified include: preexisting conduction abnormalities, septal thickness, NYHA class, and annulus perimeter.
• The TAVI PACER score demonstrated an area under the curve of 0.8, with 76% sensitivity and 72% specificity for PPMI prediction.

Conclusions:

• The TAVI PACER score offers a novel, clinically relevant tool for estimating individual PPMI risk post-TAVI.
• The score integrates preprocedural and intraprocedural factors for comprehensive risk assessment.
• This tool can aid clinicians in managing PPMI risk in TAVI patients.