Key result
Pre-procedural RBBB linked to ~156-fold greater odds of PPM implantation after TAVI.
Why the study?
The incidence and predictors of permanent pacemaker implantation after transaortic valve implantation in patients with severe symptomatic aortic stenosis and moderate to high surgical risk were not well defined.
Observational (n=100)
No
Answers are grounded in this paper and cite their sources.
In a single-center Pakistani cohort, 22% of patients undergoing TAVI required permanent pacemaker implantation, which was independently predicted by baseline RBBB and large post-deployment valve area.
Objectives: The objective of the study is to evaluate the incidence and predictors of permanent pacemaker (PPM) implantation in patients undergoing transaortic valve implantation (TAVI). Methodology: This study was conducted at the “National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan”. All the consecutive patients who underwent TAVI between July 2015 and February 2020 were included in the study. Patient data were extracted from Hospital TAVI Registry. We included patients with severe symptomatic aortic stenosis (AS) with moderate to high surgical risk as per “society of thoracic surgeon score (STS)” and “EURO II score”, underwent TAVI. Patients were stratified into two groups based on the implantation of PPM, demographic characteristics, clinical characteristics, co-morbid conditions, valve pathology, and procedural characteristics were compared between both groups. Results: Among 100 patients included only 22 patients (22%) underwent PPM implantation. The indication for implantation of PPM for all patients was complete heart block. Clinical characteristics which shows statistical significance for PPM implantation are preprocedural left ventricular dysfunction (p=0.015), right bundle branch block (RBBB) p<0.001, and left anterior hemiblock (p<0.001) noted on ECG and post-deployment valve area post-procedure (p<0.001). Multivariate analysis showed that pre-procedure RBBB and large post-deployment valve area are independent predictors for PPM implantation in Post TAVI patients. Conclusion: The incidence of PPM implantation in patients who underwent TAVI at NICVD is 22%. Preprocedural left ventricular dysfunction, RBBB, and post-procedure large post-deployment valve area were noted to be significant predictors for PPM implantation.
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Alam et al. (2022) conducted an observational in Severe symptomatic aortic stenosis (n=100). Pre-procedural right bundle branch block (RBBB) vs. Absence of RBBB was evaluated on Permanent pacemaker (PPM) implantation (OR 155.85, 95% CI 9.48-2563.18, p=<0.001). Pre-procedural right bundle branch block was a strong independent predictor of permanent pacemaker implantation after TAVI (OR 155.85), which occurred in 22% of patients overall.
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