Association Between Body Mass Index and Permanent Pacemaker Implantation in Patients Receiving Edwards Sapien 3 Transcatheter Aortic Valve

Background:
Transcatheter aortic valve replacement (TAVR) can be complicated with high degree atrioventricular block requiring permanent pacemaker (PPM) in 5-25% of patients. Association between body mass index (weight/height=kg/m2) and pacemaker implantation is not extensively studied. We studied PPM implantation in patients who received Edwards Sapien 3 TAVR valves based on their BMI class.

Methods:
It is a single center retrospective cohort analysis of 449 patients undergoing TAVR from December 2012 to April 2018. We excluded patients with TAVR valve types other than ESV3 (127 patients) and those with prior PPM or implantable cardioverter defibrillator (37 patients). Patients with aborted procedure and surgical conversion were also excluded (16). Final sample size was 269. Primary outcome was pacemaker implantation. Statistical analysis was done using Chi-square, t-test and adjusted logistic regression.

Results:
Of 269 patients (50.6% males; mean age of 79.5 ±8.7 years; mean STS score: 6.2); pacemaker implantation was seen in 17 patients (6.3%). Time to pacemaker implantation was 1.3 days. Patients were divided in four categories based on their BMI, as underweight (BMI<25; 67 patients), normal (BMI: 25~ <30; 87 patients), overweight (BMI: 30~ <35; 60 patient) and obese (BMI>=35; 55 patients). Pacemaker implantation was significantly high in patients with a BMI of >30 (13 vs. 4, p=0.037). On logistic linear regression odds of getting a PPM after TAVR were significantly high in patients who were overweight (OR: 12.77, p=0.024; CI: 1.39-117.25) and obese (OR:15.02, p=0.036, CI:1.19-189.92).

Conclusions:
Higher BMI is a possible risk factor for high degree atrioventricular block in patients receiving Edwards Sapien 3 TAVR valves.