Predicting pacemaker dependency after transcatheter aortic valve replacement: Analysis of ECG, clinical, and CT-imaging parameters

Klambauer, Konstantin ; Rizas, Konstantinos D. ; Fabritius, Matthias P. ; Fink, Nicola ; Schäfer, Verena; Mansour, Nabeel ; Utz, Christina; Grathwohl, Fabian; Kunz, Wolgang G.; Spiro, Judith E. ; Ricke, Jens; Curta, Adrian und Puhr-Westerheide, Daniel (2026): Predicting pacemaker dependency after transcatheter aortic valve replacement: Analysis of ECG, clinical, and CT-imaging parameters. In: European Journal of Radiology, Bd. 194, 112534

Abstract

Objectives

Conduction disturbances necessitating permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have been observed. However, limited data exist on ECG, clinical, and CT-imaging factors predicting PPM dependency after TAVR. This study aimed to identify predictors of pacemaker dependency in selected patients who required PPM implantation after TAVR with SAPIEN 3 prostheses.

Materials and Methods

This study included consecutive patients who underwent transfemoral TAVR with SAPIEN 3 prostheses at our institution between May 2012 and December 2019. Exclusion criteria were incomplete or non-diagnostic data, valve-in-valve procedures, TAVR in mitral position, previous surgical repair, and pre-implanted PPM. The primary endpoint was PPM dependency, defined as ventricular pacing percentage ≥ 1 % at the first outpatient follow-up after PPM implantation post-TAVR. Regression analysis was performed to compare a limited prediction model for PPM dependency using only selected variables to a full model with all available variables.

Results

Out of 2105 patients who received TAVR, 350 (16.6 %) required pacemaker implantation post-TAVR. After exclusions, 301 patients remained, with 168 (55.8 %) PPM-dependent and 133 (44.2 %) non-dependent patients. Multivariate analysis identified prosthesis oversizing (OR: 1.09, p < 0.001), calcification below the left coronary cusp (LCC) (OR: 1.02, p < 0.001), and right bundle branch block (RBBB) prior to TAVR (OR: 2.20, p = 0.025) as significant predictors. A limited regression model predicted PPM dependency with an AUC of 0.752, significantly outperforming the full model (AUC: 0.660, p = 0.037).

Conclusion

RBBB prior to TAVR was the strongest predictor of PPM dependency post-TAVR, followed by prosthesis oversizing and calcification below the LCC. A limited prediction model with these variables demonstrated moderate predictive accuracy.

• Dokumententyp: Zeitschriftenartikel
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0720048X
• Sprache: Englisch