Abstract 15996: Pre-Operative Predictors of Permanent Pacemaker Implantation Post Aortic Valve Replacement: A Retrospective Cohort Evaluation

Abstract

Introduction: Permanent pacemaker (PPM) implantation following Aortic Valve Replacement (AVR) is common. While AVR modality choice (i.e. surgical vs. transcatheter) affects PPM risk, identifying pre-operative factors associated with increased PPM risk can benefit enhanced risk assessment and care decisions. Methods: This study is a retrospective evaluation of pre-operative factors associated with PPM risk within 1-month post-AVR at a tertiary care centre (2014-2020). Pre-AVR conduction abnormalities were classified as left bundle (LBBB), right bundle branch blocks (RBBB), and other abnormalities (left anterior/posterior fascicular block, intraventricular conduction delay) in combination with RBBB, LBBB, or alone. Results: Of the 776 (mean age= 74, 66% male) patients, 89 (11.5%) subsequently received PPM. As per pre-AVR electrocardiogram, 76 (9.8) were not in sinus rhythm and 214 (27.6%) had conduction abnormalities, including: 81 (10.4%) LBBB and LBBB + other, 91 (11.7%) RBBB and RBBB + other, and 42 (5.4%) other abnormalities. Pre-AVR rhythm (18.4 vs. 10.7%, p=0.05) and conduction abnormalities (19.2 vs. 8.5%, p<0.0001) were significantly associated with the need for post-AVR PPM. No statistically significant differences were observed in other demographic-clinical characteristics. Logistic regression, adjusted for age and sex, indicated significantly higher post-AVR PPM risk for patients with RBBB and RBBB + other (OR= 3.84, 95%CI: 2.21-6.66, p<0.0001) and other miscellaneous (OR= 2.58, 95%CI: 1.13-5.93, p<0.03) abnormalities, but not for LBBB and LBBB + other (OR= 1.14, 95%CI: 0.52-2.50, p<0.75) compared to participants with no pre-AVR conduction abnormalities. Females experienced significantly lower need for PPM (OR= 0.60, 95%CI: 0.35-1.00, p= 0.05). Conclusions: Pre-AVR RBBB and other conduction abnormalities alone or together, but not LBBB are associated with significantly higher need for post-AVR PPM.