Key result
A predictive model combining preprocedural CT and ECG markers predicted post-TAVR permanent pacemaker requirement with an area under the curve of 0.73 (95% CI 0.67-0.79).
Why the study?
Permanent pacemaker implantation remains a common complication following TAVR.
Can a predictive model combining preprocedural CT and ECG markers accurately predict the need for permanent pacemaker implantation following TAVR in high-risk patients?
Observational (n=433)
Can a predictive model combining preprocedural CT and ECG markers accurately predict the need for permanent pacemaker implantation following TAVR in high-risk patients?
Effect estimate: AUC 0.73 (95% CI 0.67-0.79)
A predictive model combining preprocedural CT anatomical measurements and ECG parameters demonstrates moderate accuracy (AUC 0.73) in predicting the need for permanent pacemaker implantation after TAVR.
CT-ECG model may aid PPI risk prediction post-TAVR; leaves open prospective validation before clinical adoption.
Background: Need for permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR) remains a common complication. We aimed to assess computed tomography (CT)-based anatomical and electrocardiogram (ECG)-based parameters in a predictive model for PPI following TAVR. Methods: We assessed CT-based parameters, including the predicted course of the conduction axis from atrioventricular node to left bundle branch origin relative to the aortic virtual basal ring. Electrophysiological variables were combined in assessing a model to predict post-TAVR PPI. Results: Among 433 patients (mean age 82.0 [9.0] years, 54.0% female), 90 (21.0%) required PPI. Multiple binary logistic modeling demonstrated a shallower position of the membranous septum inferior margin midpoint increased the odds of PPI by 20% for every 1 mm (adjusted odds ratio [aOR]: 1.20) adjusted for the CT assessment phase. Increasing aortic root rotational angle associated with lower PPI odds (odds ratio [OR]: 0.98; 95% CI [0.95-1.00]), while an angle between the membranous septum midpoint and noncoronary leaflet nadir associated with increased PPI odds (OR: 1.04; 95% CI [1.01-1.08]). Preprocedural right bundle branch block and first-degree atrioventricular block associated with increased odds for PPI (OR: 3.76; 95% CI [1.71-8.21]; and OR: 1.84; 95% CI [1.06-3.18], respectively). The model had an area under the curve of 0.73 (95% CI [0.67-0.79]), sensitivity of 0.74 (95% CI [0.47-0.93]), and specificity of 0.65 (95% CI [0.40-0.87]) for predicting PPI requirement. Conclusions: A predictive model for determining the risk of PPI following TAVR is reported, combining comprehensive conduction-specific anatomical measurements relative to the aortic root and electrical measurements with clinical parameters. This model requires prospective application to understand its performance in the real-world.
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Tretter et al. (2025) conducted an observational in High-risk patients undergoing TAVR (n=433). Preprocedural CT and ECG markers was evaluated on Permanent pacemaker implantation (PPI) following TAVR (AUC 0.73, 95% CI 0.67-0.79). A predictive model combining preprocedural CT and ECG markers predicted post-TAVR permanent pacemaker requirement with an area under the curve of 0.73 (95% CI 0.67-0.79).
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