Predictors of Early and Late Atrioventricular Block Requiring Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Single-Center Experience

Muhammad Zubair Khan; Ashwani Gupta; Sona Franklin; Aida Abraham; Ahmad Jarrar; Kirten Kumar Patel; Sarah Ahmad; Steven Kutalek

doi:10.1016/j.carrev.2022.02.002

Predictors of Early and Late Atrioventricular Block Requiring Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Single-Center Experience

Cardiovasc Revasc Med. 2022 Sep:42:67-71. doi: 10.1016/j.carrev.2022.02.002. Epub 2022 Feb 9.

Authors

Muhammad Zubair Khan¹, Ashwani Gupta², Sona Franklin³, Aida Abraham³, Ahmad Jarrar³, Kirten Kumar Patel⁴, Sarah Ahmad³, Steven Kutalek⁵

Affiliations

¹ Department of Medicine, St. Mary Medical Center, Langhorne, PA, USA. Electronic address: Dr_mzubairkhan@yahoo.com.
² Department of Cardiology, St. Mary Medical Center, Langhorne, PA, USA.
³ Department of Medicine, St. Mary Medical Center, Langhorne, PA, USA.
⁴ Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA.
⁵ Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA. Electronic address: kutaleks@aol.com.

PMID: 35288044
DOI: 10.1016/j.carrev.2022.02.002

Abstract

Purpose: Complete heart block requiring permanent pacemaker can occur early following transcatheter aortic valve replacement (TAVR) due to mechanical compression of the aortic valve annulus and associated atrio-ventricular (AV) conduction system. Data are limited regarding late PM implantation after TAVR. The purpose of this study was to determine predictors of early vs. late PM implantation post-TAVR procedure.

Methods: Baseline characteristics of patients who required PM <7 days following TAVR were compared with patients who required a PM >7 days to 1 year following TAVR using Chi-Square and multivariate regression analysis.

Results: There were 362 TAVR patients, of which 39 (10.4%) received a PM after TAVR. Of these 18 (4.6%) patients required PM within 7 days after TAVR, and 21 (5.8%) required PM after 7 days and up to 1 year later. Right bundle branch block (RBBB) (OR 6.721, CI 2.3-36.9, p < 0.005) was a positive predictor of early PM placement. Left bundle branch block (LBBB) (OR = 3.5, CI 1.19-10.80, p-value < 0.05) and atrial fibrillation (AF) (OR = 3.5, 1.36-9.4 p < 0.05) were predictors for late PM. Early and late PM were associated with a longer median hospital stay compared to no PM (4.9 ± 4.86 days vs. 10.1 ± 10.04 days vs. 6.10 ± 6.02 days). The incidence of heart failure was higher in the late PM group. The overall motility was not increased in early and late PM compared to no PM.

Conclusion: Patients requiring PM implant after TAVR was 10.4%, of which 5.8% need PM >7 days post-TAVR. RBBB is a predictor for early PM. AF and LBBB were predictors for late PM.

Keywords: Atrial fibrillation; Left bundle branch block; Permanent pacemaker; Transcatheter aortic valve replacement.

MeSH terms

Aortic Valve Stenosis* / complications
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Arrhythmias, Cardiac / therapy
Atrioventricular Block* / diagnosis
Atrioventricular Block* / etiology
Atrioventricular Block* / therapy
Bundle-Branch Block / diagnosis
Bundle-Branch Block / etiology
Bundle-Branch Block / therapy
Humans
Pacemaker, Artificial* / adverse effects
Risk Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome