Abstract
Atrioventricular conduction disturbance leading to permanent pacemaker (PM) implantation is a frequent and relevant complication after transcatheter aortic valve implantation (TAVI). We aimed to evaluate the rate of post-TAVI permanent PM implantation over time and to identify the predictive factors for post-TAVI PM. The data were retrospectively collected by the Netherlands Heart Registration (NHR). In total, 7489 isolated TAVI patients between 2013 and 2019 were included in the final analysis. The primary endpoint was a permanent PM implantation within 30 days following TAVI. The incidence of the primary endpoint was 12%. Post-TAVI PM showed a stable rate over time. Using multivariable logistic regression analysis, age (OR 1.01, 95% CI 1.00–1.02), weight (OR 1.00, 95% CI 1.00–1.01), creatinine serum level (OR 1.15, 95% CI 1.01–1.31), transfemoral TAVI approach (OR 1.34, 95% CI 1.11–1.61), and TAVI post-dilatation (OR 1.58, 95% CI 1.33–1.89) were shown to be independent predictors of PM. Male sex (OR 0.80, 95% CI 0.68–0.93) and previous aortic valve surgery (OR 0.42, 95% CI 0.26–0.69) had a protective effect on post-TAVI PM. From a large national TAVI registry, some clinical and procedural factors have been identified as promoting or preventing post-TAVI PM. Further efforts are required to identify high-risk patients for post-TAVI PM and to reduce the incidence of this important issue.
Highlights
Transcatheter aortic valve implantation (TAVI) is currently the first-line therapy for patients with severe aortic stenosis who are at intermediate to high surgical risk for an unfavorable post-procedural outcome [1]
By univariable analysis (Table S1 Supplementary Materials), the following patientrelated variables were significantly associated with a higher risk of post-transcatheter aortic valve implantation (TAVI) PM: weight and creatinine serum level
Previous aortic valve surgery and male gender
Summary
Transcatheter aortic valve implantation (TAVI) is currently the first-line therapy for patients with severe aortic stenosis who are at intermediate to high surgical risk for an unfavorable post-procedural outcome [1]. Despite an ongoing trend to expand TAVI to younger and lower-risk patients, occurrence of peri-procedural conduction disturbances that lead to permanent pacemaker (PM) implantation remains a relevant shortcoming yet to be solved or substantially reduced [2,3]. Due to the proximity of the atrioventricular conduction system to the aortic valve structures, any intervention, either transcatheter or surgical at the valve level, may result in atrioventricular (AV) conduction system disturbances that can lead to permanent PM implantation [3]. The inherent features of the TAVI-related valve structure and deployment, make such an adverse event more frequent after transcatheter than surgical procedures, where post-operative PM rate reaches from 2 to 6% [4]. Male sex, and intra-procedural AVblock have been found to be independent predictive factors of peri-operative PM [3,6]
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