Background: Permanent pacemaker implant (PPI) is a frequent complication of transcatheter aortic valve replacement (TAVR), with potential long-term implications for patient morbidity and mortality. TAVR is expected to expand towards the treatment of lower-risk patients and other aortic valve pathologies; however, the current capacity within the National Health Service (NHS) to deliver TAVR is discordant with the indicative treatable burden of severe aortic stenosis. Consequently, it is of clinical relevance to identify the predictors for new-onset conduction disturbance to minimise the incidence and associated complications of PPI post-TAVR.
Aims: This study aimed to identify the burden and predictors of PPI in patients undergoing TAVR at Royal Papworth Hospital (RPH) at 12 months.
Methods: Baseline and procedural characteristics were collected retrospectively from 491 patients without prior aortic valve replacement or PPI undergoing TAVR between January 2016 and December 2020. The predictors of PPI were identified from a multivariate logistic regression model using statistically significant variables from initial univariate analyses.
Results: PPI was required in 45 patients (9.2%) and 55 patients (11.2%) at 30 days and 12 months post-TAVR, respectively. Yearly PPI incidence ranged between 6.5% and 16.7%. Overall, patients had a mean age of 81.9 ± 7.5 years, and 227 (46.2%) were female. Pre-existing right bundle branch block (RBBB; no-PPI=9.2%, PPI=30.6%; p=<0.001) conferred a 2.39 times greater risk of PPI at 12 months. Similarly, baseline first-degree atrioventricular block (FD-AVB; no-PPI=15.0%, PPI=38.8%; p<0.001) conferred a 2.13 times greater risk greater risk of PPI at 12 months. All-cause mortality at 12 months was 14.0% (n=78), with no significant difference between groups (x2 (1, N = 558 = 1.84, p=0.17).
Conclusions: The incidence of PPI post-TAVR at RPH was comparable to other UK TAVR cohorts. RBBB and FD-AVB were significant independent predictors of PPI within this cohort. The results of this study could be utilised to guide TAVR pre-assessment screening tools to identify patients who are at high risk of PPI.