Abstract 14876: Predictors of Permanent Pacemaker Insertion After TAVR: A Systematic Review and Meta-Analysis

Abstract

Introduction: Transcatheter Aortic Valve Replacement (TAVR) has evolved as the standard of care for patient with severe aortic stenosis. Conduction abnormalities leading to permanent pacemaker (PPM) implantation is one of the most common complication after TAVR. The aim of this analysis is to evaluate the predictors associated with increased risk of PPM implantation after TAVR. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. 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: 37 observational studies with 71455 patients were identified. The incidence of PPM implantation after TAVR in our analysis was 22%. The risk of PPM implantation after TAVR was more in men, it increased with increasing age, and in patients with diabetes mellitus, presence of right bundle branch block , baseline atrioventricular conduction block, and left anterior fascicular block. Significant predictors of PPM insertion post TAVR included the presence of high calcium volume in the area below left and non-coronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, pre-dilatation balloon valvuloplasty and post-implant balloon dilation. However, the risk did not increase with atrial fibrillation, left bundle branch block, baseline interventricular conduction delay, change in QRS duration after the procedure and with the presence of high calcium in the area below right coronary cusp. Conclusions: Our meta-analysis identified 14 factors that were significantly associated with increased risk of PPM insertion after TAVR. Early identification of high-risk populations and targeting modifiable risk factors can help to reduce the rate of PPM insertion after TAVR.