Key result
Pre-existing right bundle branch block (aOR 4.82) and left bundle branch block (aOR 1.63) significantly predicted the need for permanent pacemaker implantation during the same admission following TAVR.
Why the study?
TAVR is associated with conduction abnormalities requiring permanent pacemaker implantation, but data regarding predictors for PPMI following TAVR are scarce.
What are the predictors of permanent pacemaker implantation following transcatheter aortic valve replacement?
Observational (n=54,195)
Yes
What are the predictors of permanent pacemaker implantation following transcatheter aortic valve replacement?
Effect estimate: aOR 4.82 (95% CI 3.77-6.16)
p-value: p=<0.001
Baseline right bundle branch block, left bundle branch block, hypertension, and higher comorbidity burden strongly predict the need for permanent pacemaker implantation after TAVR, which is associated with longer hospital stays and higher costs.
Background: Transcatheter Aortic Valve Replacement (TAVR) is associated with conduction abnormalities requiring permanent pacemaker implantation (PPMI). Data regarding predictors for PPMI following TAVR is scarce. Methods: This is a retrospective study utilizing the 2017 National In-Patient Sample (NIS). Patients who underwent TAVR and PPMI during the same admission were identified using appropriate ICD-10 codes, as were patients with left bundle branch (LBBB), right bundle branch (RBBB), and first-degree AV delay (AVB). Patients were split into two groups based on PPMI. The groups were compared using univariate and multivariate analyses after adjusting for age, gender, race, comorbidities, insurance status, and Charlson comorbidity index (CCI). Secondary outcomes included factors influencing length of stay (LOS) and total charges incurred. Results: In 2017, 54,175 (57.6% males) patients underwent TAVR. There were 8,067 patients with LBBB, 2,402 with RBBB, and 2,905 with AVB at baseline. A 4170 total of patients (55.2% males) required PPMI. Patients requiring PPMI were older (80.5 vs 79.6 years, p=0.001). On multivariate analyses, baseline RBBB, LBBB, hypertension (HTN), CCI 2, and CCI >/=3 predicted PPMI (aOR 4.82, p<0.001; aOR 1.63, p<0.001; aOR 1.21, p=0.013, aOR 1.53, p=0.022 and aOR 1.46, p=0.031 respectively). On multivariate analyses, patients who underwent PPMI had significantly higher LOS (aOR 2.18, p<0.001) and incurred higher total charges (USD 278,000 vs USD 204,920; p<0.001). Conclusion: In this cohort, RBBB, LBBB, HTN, and increased CCI predicted PPMI after TAVR. Further studies are required to corroborate our findings.
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Krishnan et al. (2023) conducted an observational in Transcatheter Aortic Valve Replacement (TAVR) (n=54,195). Pre-existing right bundle branch block (RBBB) vs. Absence of RBBB was evaluated on Permanent pacemaker implantation (PPMI) during the same admission (aOR 4.82, 95% CI 3.77-6.16, p=<0.001). Pre-existing right bundle branch block (aOR 4.82) and left bundle branch block (aOR 1.63) significantly predicted the need for permanent pacemaker implantation during the same admission following TAVR.
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