Lower interventricular septal thickness from computed tomography predicts the need for pacemaker implantation after...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe aortic stenosis (AS).
• Predictors for permanent pacemaker implantation (PPI) post-TAVR include membranous septum length and pre-existing conduction disturbances.
• The role of muscular interventricular septal (IVS) thickness, assessed by pre-procedural CT, in predicting PPI after TAVR is not well-established.

Purpose of the Study:

• To investigate the predictive value of interventricular septal (IVS) thickness, measured by cardiac computed tomography (CT), for permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR).

Main Methods:

• Retrospective cohort study of 338 patients undergoing TAVR (January 2019 - December 2022).
• Pre-procedural CT scans were used to measure end-systolic IVS thickness at multiple levels below the membranous septum.
• Multivariable logistic regression analysis was performed to identify predictors of PPI, including IVS thickness.

Main Results:

• 20.1% of patients required PPI post-TAVR.
• Significantly lower IVS thickness was observed in patients needing PPI at 2mm, 5mm, and 10mm below the membranous septum (p < 0.001 for all).
• Independent predictors of PPI included thinner IVS thickness at 10mm below the septum (HR: 0.73), shorter membranous septum length (HR: 0.79), and right bundle branch block (HR: 7.70).

Conclusions:

• Pre-procedural interventricular septal (IVS) thickness measured by CT is an independent predictor of permanent pacemaker implantation (PPI) after TAVR.
• Incorporating IVS thickness into risk assessment models can improve the prediction of PPI in TAVR patients.