P5978Mechanical dispersion is a predictor of 30-day permanent pacemaker implantation after transcatheter aortic valve replacement

Abstract

Abstract Background Transcatheter aortic valve replacement (TAVR) related conduction disturbance resulting in permanent pacemaker (PPM) implantation is a common complication. The mechanical effects of these conduction abnormalities can be measured as regional heterogeneity of contraction by myocardial strain imaging. Objectives The aim of this study was to investigate whether post-TAVR left ventricular mechanical dispersion (MD) can predict PPM implantation. Methods We retrospective analyzed 137 patients (48% men, 80±9 years) who underwent TAVR at our institution after excluding patients with pre-existing PPM. 2D speckle-tracking echocardiography was used to assess MD (SD of time from Q/R on the ECG to peak strain in 16 LV segments) immediately after TAVR (median, 1 day). Images were analyzed offline using a vendor-independent software (TomTec). Results At 30-days post-TAVR, 14 (10.2%) patients underwent PPM implantation. Patients requiring PPM had more pronounced MD (p=0.012), pre-existing RBBB (p=0.017), pre-existing LAHB (p<0.001), and peri-procedural AVB (p=0.005). Multivariate Cox regression analysis of important clinical covariates (model 1 = age, sex, RBBB, LAHB, AVB) showed significant predictive value for PPM implantation (chi-square 41.8, p<0.001). Addition of MD to the model resulted in a significant chi-square increase (from 41.8 to 47.3, p=0.01). Conclusion Left ventricular MD, measured immediately after TAVR, was associated with 30-day PPM and provided incremental predictive value to important clinical variables.