Predictors of permanent pacemaker insertion after TAVR: A systematic review and updated meta-analysis

Authors

Sugandhi Mahajan, Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.Follow
Rahul Gupta MD, Lehigh Valley Health NetworkFollow
Aaqib H. Malik, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.Follow
Pranav Mahajan, Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.Follow
Surya K. Aedma, Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.Follow
Wilbert S. Aronow, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.Follow
Sanjay S. Mehta, Department of Cardiology, Heart and Vascular Institute, Carle Foundation Hospital, Urbana, Illinois, USA.Follow
Dhanunjaya R. Lakkireddy, Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA.Follow

Document Type

Article

Publication Date

5-1-2021

Publication Title

Journal of cardiovascular electrophysiology

E-ISSN

1540-8167

Department(s)

Cardiology Division; Fellows and Residents

Keywords

conduction disturbances, meta-analysis, permanent pacemaker, predictors, transcatheter aortic valve replacement

Abstract

OBJECTIVES: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR). BACKGROUND: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications. METHODS: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. RESULTS: Thirty-seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation. CONCLUSION: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.

Volume

32

Issue

5

First Page

1411

Last Page

1420

DOI

10.1111/jce.14986

PubMed ID

33682218

Recommended Citation

Mahajan, S., Gupta, R., Malik, A. H., Mahajan, P., Aedma, S. K., Aronow, W. S., Mehta, S. S., & Lakkireddy, D. R. (2021). Predictors of permanent pacemaker insertion after TAVR: A systematic review and updated meta-analysis. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/research-historical-works/65
DOI: 10.1111/jce.14986