Abstract 18472: Electrocardiographic and Imaging Predictors for Permanent Pacemaker (PPM) Implantation Following Transcatheter Aortic Valve Replacement (TAVR)

Abstract

Hypothesis: The purpose of this study was to identify predictors of permanent pacemaker (PPM) placement post-TAVR. Introduction: Cardiac conduction abnormalities requiring PPM are well-recognized complications of TAVR. Reliable predictors of post-TAVR PPM placement, however, remain elusive. Methods: A total of 114 patients who underwent trans-apical or trans-femoral TAVR using the balloon-expandable Edwards SAPIEN valve at the University of Iowa Hospitals and Clinics were identified. We then excluded patients with a pre-existing pacemaker and who required conversion to an open/salvage procedure. We performed a retrospective chart review aimed at abstracting raw data related to patient characteristics, EKG variables, imaging, procedural variables, outcomes, and follow-up data. Univariate and multivariate logistic regression was performed, with post-TAVR PPM implantation as the outcome. Results: A total of 100 patients were included in the study and PPM was placed in 9 patients (9%). AV block was the indication for all PPM. In univariate analysis, the ratio of valve size to diameter of Sinus of Valsalva was a significant predictor of PPM (84.1±9.3 vs 76.8±7.1, p=0.009) (Table 1). In multivariate analysis, using right bundle branch block (RBBB), sex and the ratio of valve size to diameter of Sinus of Valsalva as predictors, pre-existing (RBBB) (OR: 6.5, 95% CI: 1.1-37.1, p=0.035) was identified as a predictor of PPM and the ratio of valve size to diameter of Sinus of Valsalva (OR: 1.2, 95% CI: 1.03-1.3, p=0.012) was identified as a novel predictor of PPM. Conclusions: PPM placement was required in 9% of patients without pre-existing PPM who underwent TAVR. In addition to pre-existing RBBB, the ratio of valve size to diameter of Sinus of Valsalva was identified as a novel predictor of PPM after TAVR. Our findings differ from prior published manuscripts which reported valve size to LV outflow tract diameter ratio as a significant predictor of post-TAVR PPM implantation.