Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: A contemporary meta-analysis of 981,168 patients

Anan A. Abu Rmilah; Hossam Al-Zu’bi; Ikram-Ul Haq; Asil H. Yagmour; Suhaib A. Jaber; Adham K. Alkurashi; Ibraheem Qaisi; Gurukripa N. Kowlgi; Yong-Mei Cha; Siva Mulpuru; Christopher V. DeSimone; Abhishek J. Deshmukh

doi:10.1016/j.hroo.2022.05.001

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Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: A contemporary meta-analysis of 981,168 patients

Journal article

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Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: A contemporary meta-analysis of 981,168 patients

Anan A. Abu Rmilah, Hossam Al-Zu’bi, Ikram-Ul Haq, Asil H. Yagmour, Suhaib A. Jaber, Adham K. Alkurashi, Ibraheem Qaisi, Gurukripa N. Kowlgi, Yong-Mei Cha, Siva Mulpuru, …

Heart rhythm O2, Vol.3(4), pp.385-392

08/01/2022

DOI: 10.1016/j.hroo.2022.05.001

PMCID: PMC9463692

PMID: 36097458

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Abstract

Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.

Atrioventricular block

Bundle branch block

Conduction disturbance

Pacemaker

Transcatheter aortic valve replacement

Details

Title: Subtitle: Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: A contemporary meta-analysis of 981,168 patients
Creators: Anan A. Abu Rmilah - Mayo Clinic
Hossam Al-Zu’bi - Mayo Clinic
Ikram-Ul Haq - Mayo Clinic
Asil H. Yagmour - Al-Quds University
Suhaib A. Jaber - Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi Arabia
Adham K. Alkurashi - Mayo Clinic
Ibraheem Qaisi - An-Najah National University
Gurukripa N. Kowlgi - Mayo Clinic
Yong-Mei Cha - Mayo Clinic
Siva Mulpuru - Mayo Clinic
Christopher V. DeSimone - Mayo Clinic
Abhishek J. Deshmukh - Mayo Clinic
Resource Type: Journal article
Publication Details: Heart rhythm O2, Vol.3(4), pp.385-392
DOI: 10.1016/j.hroo.2022.05.001
PMID: 36097458
PMCID: PMC9463692
NLM abbreviation: Heart Rhythm O2
ISSN: 2666-5018
eISSN: 2666-5018
Publisher: Elsevier Inc
Number of pages: 8
Language: English
Date published: 08/01/2022
Academic Unit: Internal Medicine
Record Identifier: 9984845249402771

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