Predictive Risk Score for Need for Pacemaker After TAVR

Nov 15, 2019
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Authors:
Kiani S, Kamioka N, Black GB, et al.
Citation:
Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019;12:2133-2142.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

How well does a predictive risk score predict the need for new pacemaker implantation (PMI) after transcatheter aortic valve replacement (TAVR)?

Methods:

Multivariate analysis was performed to evaluate for predictors of PMI in the TAVR population (n = 778), and this model was used to develop the Emory risk score (ERS), which was tested in a validation cohort (n = 367).

Results:

There were 1,266 patients undergoing elective TAVR with the Edwards SAPIEN 3. Fifty-seven patients (7.3%) in the derivation cohort required PMI. In a regression model, history of syncope (odds ratio [OR], 2.5; p = 0.026), baseline right bundle branch block (OR, 4.3; p < 0.001), QRS duration ≥138 ms (OR, 2.5; p = 0.017), and valve oversizing >15.6% (OR, 1.9; p = 0.041) remained independent predictors of PMI and were included in the ERS. The ERS was strongly associated with PMI (per point increase OR, 2.2; p < 0.001) with an area under the receiver-operating characteristic curve of 0.778 (p < 0.001), which was similar to its performance in the derivation cohort.

Conclusions:

A history of syncope, right bundle branch block, longer QRS duration, and higher degree of oversizing are predictive of the need for PMI after TAVR.

Perspective:

Implantation of the Edwards SAPIEN 3 valve has been associated with a higher rate of PMI than in previous versions of balloon-expandable valves. Present research shows that history of syncope as well as wide QRS are predictive of the decision to implant a pacemaker.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Arrhythmias, Cardiac, Bundle-Branch Block, Geriatrics, Heart Block, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Pacemaker, Artificial, Risk Factors, Secondary Prevention, Syncope, Transcatheter Aortic Valve Replacement


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