TCTAP A-054 Incidence and Predictors of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement.

Abstract

Transcatheter aortic valve replacement (TAVR)has become the standard of care for patients with severe aortic stenosis at high risk for surgery. However, it is associated with a high rate of permanent pacemaker (PPM) implantation. TAVR is now being performed in many centres across the middle east. There is limited data regarding the outcomes of patients undergoing TAVR in this region. The aim of our study was to assess the rates of PPM implantation post TAVR at our institution and to study the factors that could predict the need for one. Method(s): This was a retrospective study involving all patients undergoing TAVR at our institution over a 5-year period from 2015 to 2020. We included patients who survived the procedure to discharge and those that were followed up for one year post procedure. All clinical data was obtained from the electronic case notes of the patients who were identified from our cardiology catheter lab database. Ethical approval was obtained from our Medical ethics committee Results: A total of 153 patients (age: 74.2+/-8.2 years; Male 82 (53.6%), Female 71 (46.4%)) were enrolled into the study. Of these, 15patients (age 74.3+9.8 years, 46.6%male) had required a permanent pacemaker within one year of follow up, giving a pacemaker implantation rate of 9.8%following TAVI in our cohort of patients. Tenof the 15 implants were performed within the first two weeks of the TAVI, with the median delay after TAVI being 6 days (IQR of 3-90 days). At one month, 2 of the 12 patients who had a pacing check had 0% pacing. At 6 months, this increased to 3 of the 8 patients who had a pacing check who were not pacing. At one year, 5 of the 8 patients who had a pacing check were not being paced. The factors that predicted the requirement of a pacemaker were pre-existing RBBB (OR 10.9, 95% CI 3.31-36.33,p<0.001), abnormal QRS axis (OR 9.11, 95% CI 2.77-29.91, p<0.001),prolonged QRS duration (OR 3.26 95%CI 1.06-9.92, p=0.03), and any pre-existing conduction abnormality (OR 1.18, 95% CI 1.08-1.29, p=0.01) Conclusion(s): The rates of pacemaker implantation post TAVI procedure at our institution are similar to those published in literature. The risk factors for requiring a pacemaker are also similar. However, our data seems to suggest that a sizeable proportion of these patients appear to regain their normal conduction. It might be worthwhile observing patients with conduction abnormalities before implanting a pacemaker.Copyright � 2024