Predictors of Late (≥ 30-days) Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Al Obaidi, Nawar

Predictors of Late (≥ 30-days) Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Alexis Okoh , Newark Beth Israel Medical Center, Newark, NJ

Nawar Al Obaidi , Newark Beth Israel Medical Center, Newark, NJ

Nicky Haik, BS , Newark Beth Israel Medical Center, Newark, NJ

Swaiman Singh, MD , Newark Beth Israel Med Ctr Card, Newark, NJ

Gregory M Burkman, MD , Drexel University College of Medicine, Philadelphia, PA

Justin L Gold, BS , Cooper Medical School of Rowan University, Camden, NJ

Aakash Garg, MD , Newark Beth Israel Medical Center, Newark, NJ

Setri Fugar, M.D. , Rush University Medical Center, Chicago, IL

Chunguang Chen, MD , Newark Beth Israel Medical Center, Chicago, IL

Bruce J Haik, M.D. , Saint Barnabas Medical Center, West Orange, NJ

Marc Cohen, M.D. , Newark Beth Israel Hospital, Newark, NJ

Steven P Kutalek, MD , Drexel University College of Medicine, Philadelphia, PA

Mark J. Russo, M.D. , RWJBarnabas Health, Newark, NJ

Background:
This study sought to determine predictors of advanced conduction disturbances requiring late (≥ 30-days) permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR).

Methods:
A prospectively maintained TAVR database was queried to identify all patients who had TAVR at a high-volume center. Patients with a history of PPI and those who required PPI prior to discharge from index hospitalization were excluded. The final cohort was divided into two groups based on their incidence of late PPI. Baseline clinical and electrocardiographic characteristics were compared between both groups. Predictors of late PPI were investigated using multivariable logistic regression analysis.

Results:
Overall population included 1,163 patients. We excluded 170 patients who already had a PP and 110 patients who received a PP prior to discharge after TAVR. The final analysis included 883 patients. Twenty-four patients (2.7%) developed an advanced conduction disturbance requiring PPI ≥ 30 days following TAVR. Patients who required a late PPI had a wider QRS width (120 ± 31 ms vs. 103 ± 25 ms; p = 0.001), PR interval (202 ± 25 ms vs 180 ± 39 ms; p=0.018), a higher prevalence of baseline left bundle branch block (16.6 % vs. 5.5%; p = 0.021) and were more likely to have a self-expandable (SE) valve implanted (79.2% vs. 20.8%; p= 0.002). Multivariable analysis revealed that baseline QRS width (odds ratio per 1-ms increase: 1.02; 95% confidence interval:1.01 to 1.04; p = 0.005), valve type [SE] (odds ratio: 7.3; 95% confidence interval: 2.02 to 26.6 p = 0.002) and procedure year [2015/16 vs 2017/18] (odds ratio: 4.08; 95% confidence interval: 1.01 to 15.1; p = 0.035) are independent predictors of late PPI.

Conclusions:
Among TAVR patients discharged home with no indication of PPI, baseline QRS width and a SE valve are independent predictors of advanced conduction disturbances requiring a late PPI. Meticulous follow is warranted in those with a widened QRS at baseline.