Key result
Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation.
Why the study?
Heart block requiring permanent pacemaker implantation is a relatively frequent complication of TAVR, warranting an updated assessment of clinically useful predictors.
What are the clinical and procedural predictors of permanent pacemaker implantation in patients undergoing transcatheter aortic valve replacement?
Meta-Analysis (n=981,168)
What are the clinical and procedural predictors of permanent pacemaker implantation in patients undergoing transcatheter aortic valve replacement?
Multiple baseline clinical, electrocardiographic, and procedural factors can be used to stratify the risk of requiring a permanent pacemaker after TAVR, aiding in preprocedural clinical decision-making.
Supports pre-TAVR risk stratification and monitoring; extends evidence with a proposed scoring system for high- versus low-risk patients.
Background: Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective: The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods: Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results: ) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion: Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
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Rmilah et al. (2022) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=981,168). Clinical and procedural predictors (e.g., male gender, age ≥80 years, RBBB, Medtronic CoreValve) was evaluated on Permanent pacemaker (PPM) implantation post-TAVR. Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation.
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