Abstract 18669: A Simple Noninvasive Score for Predicting Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement
Introduction: Cardiac conduction abnormalities requiring permanent pacemaker (PPM) are well-recognized complications of TAVR. However, a clinical prediction tool for assessing the risk of post-TAVR PPM placement is not available.
Hypothesis: The purpose of this study was to create a novel clinical prediction tool for assessing the risk of PPM following TAVR.
Methods: A total of 114 patients who underwent TAVR using the balloon-expandable Edwards SAPIEN valve at the University of Iowa Hospitals and Clinics were identified. We then excluded patients with a pre-existing PPM, who required conversion to an open/salvage procedure, and those without available CT data. Binomial logistic multivariate regression was performed to construct a scoring system.
Results: A total of 84 patients were included in the study and PPM was placed in 9 patients (10.7%). From the binomial logistic regression analysis using RBBB, valve size to Sinus of Valsalva diameter ratio, and sex as predictors, pre-existing RBBB (odds ratio [OR]: 6.5, 95% confidence ratio [CI]: 1.1-37.1, p=0.035) and the ratio of valve size to diameter of Sinus of Valsalva (OR: 1.2, 95% CI: 1.03-1.3, p=0.012) were identified as significant predictors of PPM post-TAVR. We created a novel clinical prediction tool for PPM post-TAVR with patients being designated with score 0 if they had no RBBB and valve size to diameter of sinus of Valsalva ratio < 81.4 (optimal cut-off based on ROC curve) and score 1 if they had RBBB, or valve size to diameter of sinus of Valsalva ratio ≥ 81.4, or both (OR: 12.6, 95% CI: 1.5-106.8, p=0.009; sensitivity, 0.90; specificity, 0.59).
Conclusions: Our clinical prediction score for PPM following TAVR expands upon the available literature for pre-procedural risk-stratification. The components of the score have biological plausibility, as pre-existing conduction system disease and relative valve prosthesis oversizing would be expected to confer a higher risk of post-procedural AV block. Implantation of PPM prior to TAVR in patients at risk for high-grade AV conduction abnormalities, based on this simple risk score, could have important implications for morbidity/mortality, length of stay, and cost. Moving forward, this prediction score requires validation in multicenter cohorts.
Author Disclosures: J.M. Routh: None. L. Joseph: None. B.R. Marthaler: None. P. Bhave: None.
- © 2015 by American Heart Association, Inc.