Key result
Pre-TAVR RBBB is linked to a ~120% increase in pacemaker dependency post-TAVR.
Why the study?
Limited data exist on ECG, clinical, and CT-imaging factors predicting pacemaker dependency after TAVR.
Does a limited prediction model including RBBB, prosthesis oversizing, and calcification below the LCC predict pacemaker dependency in patients requiring permanent pacemaker implantation after TAVR?
Cohort (n=301)
No
Does a limited prediction model including RBBB, prosthesis oversizing, and calcification below the LCC predict pacemaker dependency in patients requiring permanent pacemaker implantation after TAVR?
Odds Ratio: 2.2 (95% CI 1.12–4.44)
p-value: p=0.025
A limited prediction model incorporating pre-TAVR RBBB, prosthesis oversizing, and calcification below the left coronary cusp can moderately predict true pacemaker dependency in patients requiring PPM after SAPIEN 3 TAVR.
May inform post-TAVR monitoring; leaves open prospective validation of ECG and CT predictors before guiding practice.
OBJECTIVES: Conduction disturbances necessitating permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have been observed. However, limited data exist on ECG, clinical, and CT-imaging factors predicting PPM dependency after TAVR. This study aimed to identify predictors of pacemaker dependency in selected patients who required PPM implantation after TAVR with SAPIEN 3 prostheses. MATERIALS AND METHODS: This study included consecutive patients who underwent transfemoral TAVR with SAPIEN 3 prostheses at our institution between May 2012 and December 2019. Exclusion criteria were incomplete or non-diagnostic data, valve-in-valve procedures, TAVR in mitral position, previous surgical repair, and pre-implanted PPM. The primary endpoint was PPM dependency, defined as ventricular pacing percentage ≥ 1 % at the first outpatient follow-up after PPM implantation post-TAVR. Regression analysis was performed to compare a limited prediction model for PPM dependency using only selected variables to a full model with all available variables. RESULTS: Out of 2105 patients who received TAVR, 350 (16.6 %) required pacemaker implantation post-TAVR. After exclusions, 301 patients remained, with 168 (55.8 %) PPM-dependent and 133 (44.2 %) non-dependent patients. Multivariate analysis identified prosthesis oversizing (OR: 1.09, p < 0.001), calcification below the left coronary cusp (LCC) (OR: 1.02, p < 0.001), and right bundle branch block (RBBB) prior to TAVR (OR: 2.20, p = 0.025) as significant predictors. A limited regression model predicted PPM dependency with an AUC of 0.752, significantly outperforming the full model (AUC: 0.660, p = 0.037). CONCLUSION: RBBB prior to TAVR was the strongest predictor of PPM dependency post-TAVR, followed by prosthesis oversizing and calcification below the LCC. A limited prediction model with these variables demonstrated moderate predictive accuracy.
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Klambauer et al. (2025) conducted a cohort in Pacemaker dependency after transcatheter aortic valve replacement (TAVR) (n=301). Right bundle branch block (RBBB) prior to TAVR vs. Absence of RBBB prior to TAVR was evaluated on Pacemaker dependency (ventricular pacing percentage ≥ 1% at the first outpatient follow-up after PPM implantation) (OR 2.20, 95% CI 1.12-4.44, p=0.025). Right bundle branch block prior to TAVR was the strongest independent predictor of pacemaker dependency post-TAVR (OR 2.20), followed by prosthesis oversizing and calcification below the left coronary cusp.
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