Sugandhi Mahajan1, Rahul Gupta2, Aaqib H Malik3, Pranav Mahajan1, Surya K Aedma1, Wilbert S Aronow3, Sanjay S Mehta4, Dhanunjaya R Lakkireddy5. 1. Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA. 2. Department of Cardiology, Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA. 3. Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA. 4. Department of Cardiology, Heart and Vascular Institute, Carle Foundation Hospital, Urbana, Illinois, USA. 5. Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA.
Abstract
OBJECTIVES: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). BACKGROUND: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications. METHODS: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. RESULTS: Thirty-seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation. CONCLUSION: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
OBJECTIVES: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). BACKGROUND: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications. METHODS: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. RESULTS: Thirty-seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation. CONCLUSION: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
Authors: Thijmen W Hokken; Marjo de Ronde; Quinten Wolff; Thom Schermers; Joris F Ooms; Maarten P van Wiechen; Isabella Kardys; Joost Daemen; Peter P de Jaegere; Nicolas M Van Mieghem Journal: Catheter Cardiovasc Interv Date: 2021-11-27 Impact factor: 2.585
Authors: Philipp Maximilian Doldi; Lukas Stolz; Felix Escher; Julius Steffen; Jonas Gmeiner; Daniel Roden; Marie Linnemann; Kornelia Löw; Simon Deseive; Thomas J Stocker; Martin Orban; Hans Theiss; Konstantinos Rizas; Adrian Curta; Sebastian Sadoni; Joscha Buech; Dominik Joskowiak; Sven Peterss; Christian Hagl; Steffen Massberg; Jörg Hausleiter; Daniel Braun Journal: J Clin Med Date: 2022-03-12 Impact factor: 4.241