Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry

• Published in: International journal of cardiology Vol. 175; no. 2; pp. 248 - 252
• Main Authors: Gensas, Caroline S, Caixeta, Adriano, Siqueira, Dimytri, Carvalho, Luiz A, Sarmento-Leite, Rogério, Mangione, José A, Lemos, Pedro A, Colafranceschi, Alexandre S, Caramori, Paulo, Ferreira, Maria Cristina, Abizaid, Alexandre, Brito, Fábio S
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-08-2014; Elsevier
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Brazil - epidemiology; Cardiac Pacing, Artificial - trends; Cardiology. Vascular system; Cardiovascular; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Pacemaker; Pacemaker, Artificial - trends; Predictive Value of Tests; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Transcatheter aortic valve implantation; Transcatheter aortic valve implantation complications; Transcatheter Aortic Valve Replacement - trends; South America; Brazil; America; Transcatheter aortic valve implantation; Pacemaker; Transcatheter aortic valve implantation complications; Permanent; Predictor; Prediction; Instrumentation therapy; Implantation; Cardiovascular disease; Knowledge; Instrumental stimulation; Requirement; Need; Register; Complication; Cardiology; Predictive factor; Aortic valve
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.05.020

Abstract Background The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. Methods Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. Results At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p = 0.07), have pre-dilation (68.42% vs. 60.07%, p = 0.15), receive CoreValve (93.68% vs. 82.55%, p = 0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p < 0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56–11.49; p = 0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20–8.82; p < 0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02–3.02; p = 0.04) were independent predictors of PPM implantation. Conclusion PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.