Association of Dexmedetomidine Use With Complete Heart Block After Transcatheter Aortic Valve Replacement: A...

Complete heart block requiring permanent pacemaker (PPM) implantation is a known complication after transcatheter aortic valve replacement (TAVR). Dexmedetomidine (DEX) reduces postoperative delirium but is associated with hypotension, bradycardia, and conduction abnormalities. To date, DEX has not been implicated as an independent risk factor for PPM after TAVR. The authors hypothesized that intraoperative DEX use would increase PPM rates after TAVR.

Retrospective cohort study.

Single center from January 1, 2019, to July 1, 2025.

Two thousand twenty-two TAVRs performed under monitored anesthesia care without pre-existing PPM were included.

None.

DEX use was categorized into 4 levels: no DEX (786 patients), low dose (<1 μg/kg, 354 patients), medium dose (1-2 μg/kg, 581 patents), and high dose (>2 μg/kg, 301 patients). DEX use was not associated with PPM at any dose: low dose, odds ratio (OR) of 0.98 (95% confidence interval [CI], 0.64-1.50; p = 0.92); medium dose, OR of 0.78 (95% CI, 0.50-1.22; p = 0.28), or high dose, OR of 1.05 (95% CI, 0.61-1.82; p = 0.85). Propensity-matched analysis demonstrated no difference in PPM rates between DEX and no-DEX (9.1% v 10.2%, p = 0.61). Higher PPM rates were observed in male patients (OR, 1.89; 95% CI, 1.36-2.64; p < 0.001), dialysis patients (OR, 2.32; 95% CI, 1.11-4.86; p = 0.025), patients with high-risk preoperative electrocardiograms (OR, 2.64; 95% CI, 1.75-3.99; p < 0.001), and patients receiving self-expanding valves (OR, 2.65; 95% CI, 1.77-3.96; p < 0.001). Larger self-expanding valves (OR, 1.25; 95% CI, 1.12-1.39; p < 0.001), post-balloon dilation (OR, 1.51; 95% CI, 1.05-2.18; p = 0.028), and ventricular valve deployment increased PPM risk, while aortic deployment reduced risk (OR, 0.96; 95% CI, 0.94-0.98; p < 0.001).

DEX use during TAVR was not associated with increased risk of postprocedural PPM implantation.