TY - JOUR
T1 - Predicting permanent pacemaker implantation following transcatheter aortic valve replacement
T2 - A contemporary meta-analysis of 981,168 patients
AU - Abu Rmilah, Anan A.
AU - Al-Zu'bi, Hossam
AU - Haq, Ikram Ul
AU - Yagmour, Asil H.
AU - Jaber, Suhaib A.
AU - Alkurashi, Adham K.
AU - Qaisi, Ibraheem
AU - Kowlgi, Gurukripa N.
AU - Cha, Yong Mei
AU - Mulpuru, Siva
AU - DeSimone, Christopher V.
AU - Deshmukh, Abhishek J.
N1 - Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2022/8
Y1 - 2022/8
N2 - Background: Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective: The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods: Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results: We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion: Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
AB - Background: Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective: The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods: Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results: We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion: Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
KW - Atrioventricular block
KW - Bundle branch block
KW - Conduction disturbance
KW - Pacemaker
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85131841802&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131841802&partnerID=8YFLogxK
U2 - 10.1016/j.hroo.2022.05.001
DO - 10.1016/j.hroo.2022.05.001
M3 - Article
AN - SCOPUS:85131841802
SN - 2666-5018
VL - 3
SP - 385
EP - 392
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 4
ER -