Abstract 12786: Predictors of Intermediate to Long-Term Ventricular Pacing Requirement Following Transcatheter Aortic Valve Replacement

Abstract

Objectives: To identify factors associated with persistent atrioventricular (AV) block in patients with permanent pacemaker (PPM) in the peri-transcatheter aortic valve replacement (TAVR) setting. Background: Patients undergoing TAVR may develop AV block requiring pacing. However, whether there are patients who recover AV conduction over time is unknown. Methods: Patients who underwent TAVR and either had pre-existing PPM implanted for sinus node dysfunction or required PPM implantation during the peri-procedural TAVR period were identified from two hospitals in the University of North Carolina Health system. Demographic, electrocardiographic, echocardiographic, and procedural characteristics were abstracted. PPM data was abstracted from remote and in-person PPM interrogations at intermediate (1-12 mo) and long-term (>12 mo) checks. Patients were separated into cohorts with negligible (<1%) or significant (>1%) ventricular pacing burdens. Bivariable and multivariable analyses were performed to identify factors associated with a significant ventricular pacing requirement. Results: The cohort consisted of 159 patients with PPM implanted prior to (n=38) or in the peri-procedural (n=121) TAVR period. Bivariate analyses identified pre-procedural RBBB (17.1% vs 42.9%, p=0.007) and post-procedural RBBB (15.2% and 39.3%, p=0.015) with significant ventricular pacing requirement in the intermediate or long-term period after TAVR. In multivariate analyses, atrial fibrillation (AF) (OR 5, 95% CI 1.78-16.6, p=0.003) and RBBB (OR 11, 95% CI 2.2-100.0, p=.008) in the post-TAVR period were associated with significant ventricular pacing requirements. Patients without AF or RBBB less often required significant ventricular pacing in the intermediate (19.3% vs 80.7%) or long-term periods (19.8% vs 80.2%) after TAVR. Conclusions: Post-procedure RBBB or a history of AF predict long-term persistence of AV block post-TAVR. However, patients without RBBB or AF less often require long-term ventricular pacing and may be candidates for temporary or more basic pacing options (e.g. leadless ventricular devices) as necessary in the peri-op period.