Predictors of Permanent Pacemaker Implantation Following Valve-in-Valve Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is a growing procedure for degenerated aortic valves.
• Permanent pacemaker implantation (PPI) after TAVR increases patient morbidity and mortality.
• Predictors for PPI specifically after ViV-TAVR are not well-established.

Purpose of the Study:

• To determine clinical and procedural factors that predict the need for PPI in patients undergoing ViV-TAVR.
• To improve risk stratification and procedural planning for ViV-TAVR procedures.

Main Methods:

• Retrospective observational study of 261 consecutive ViV-TAVR patients (2012-2022).
• Analysis of clinical, ECG, procedural, and fluoroscopic data.
• Propensity score matching and multivariable logistic regression to identify PPI predictors.

Main Results:

• 9.2% of patients (24/261) required PPI.
• Predictors for PPI included preprocedural bifascicular block, greater septal implantation depth, and new post-procedural left or right bundle branch blocks.
• Aortic regurgitation as the reason for valve failure was associated with lower odds of PPI.

Conclusions:

• Bifascicular block, increased septal depth, and new bundle branch blocks are key predictors of PPI post-ViV-TAVR.
• Aortic regurgitation may be protective against PPI.
• Careful risk stratification and procedural planning are essential for patients undergoing ViV-TAVR.