Clinical impact of right ventricular pacing burden in patients with post-transcatheter aortic valve replacement permanent pacemaker implantation

Figures

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  Figure 1. Schematic illustration of cardiac conduction system on cardiac computed tomography and aortic angiogram. Reconstructed coronal view of cardiac computed tomography (A), schematic illustration of cardiac conduction system on cardiac computed tomography (B), aortic aortogram in patient with deep valve implantation (C), and aortic aortogram in patient with shallow valve implantation (D). AVN, atrioventricular node; HisB, His bundle; LBB, left bundle branch; LV, left ventricle; MS, membranous septum; NCC, non-coronary cusp; RA, right atrium; RBB, right bundle branch; ΔMSID, the difference between the MS length and the implantation depth.

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  Figure 2. Linear-spline cox regression analysis of right ventricular pacing burden. All-cause mortality (A), cardiac mortality (B), heart failure readmission (C), and the composite endpoint of cardiac mortality and/or heart failure readmission (D). TAVR, transcatheter aortic valve replacement.

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  Figure 3. Clinical outcomes of 1 year right ventricular pacing burden ≥30% cumulative incidence curves evaluated by landmark analysis with cut-off at 1 year for long-term outcomes: all-cause mortality (A), cardiac mortality (B), heart failure readmission (C), and the composite of cardiac mortality and/or heart failure readmission (D). CI, confidence interval, HR, hazard ratio; TAVR, transcatheter aortic valve replacement.

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  Figure 4. Risk factors of 1 year right ventricular pacing burden ≥30% the area under the receiving curve in receiver-operator curve demonstrated predictive accuracy of each parameter: the cumulative right ventricular pacing burden ≥40% 1 month after the post-TAVR PPM implantation (A), the TAVR valve implantation depth measured from non-coronary cusp (NCC) ≥ 4.0 mm (B), Pre-TAVR RBBB (C), and PPM indication with CHB (D). AUC, area under the receiving curve in receiver-operator curve; CHB, complete heart block; CI, confidence interval; NCC, non-coronary cusp; NPV, negative predictive value; PPM, permanent pacemaker; PPV, positive predictive value; RBBB, right bundle branch block; ROC, receiver-operator curve; RV, right ventricular; TAVR, transcatheter aortic valve replacement.

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  Figure 5. Risk-prediction models on 1 year right ventricular pacing burden ≥30%. Regarding the figures about the suggested models in figure 5, the Y-axis means the estimated risk (%) of development of RVPB >30% at one year after the post-TAVR PPM implantation. The X-axis means the summed score in each patient. CHB, complete heart block; CI, confidence interval; NCC, non-coronary cusp; PPM, permanent pacemaker; RBBB, right bundle branch block, RV, right ventricular; RVPB, right ventricular pacing burden; TAVR, transcatheter aortic valve replacement.