Echocardiographic Anatomical Risk Factors for Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.

Introduction: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with aortic valve disease. However, the need for pacemaker implantation remains a frequent complication. The objectives of this study were to estimate the incidence of permanent pacemaker implantation and to determine the associated risk factors.

Methods: This is a retrospective cohort study of adults who underwent TAVR, developed cardiac conduction disease, and required permanent pacemaker implantation during hospitalization. Groups were compared according to post procedure pacemaker implantation or not; and recognized preoperative and echocardiographically identified anatomic factors related to the procedure were evaluated. A predictive model was generated using multiple logistic regression.

Results: A total of 234 patients were included. The pacemaker implantation rate was 14%, and risk factors associated with this procedure were age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.01 - 1.22), female sex (OR 0.11, 95% CI 0.01 - 0.61), body surface area > 1.51 m2 (OR 9.78, 95% CI 2.13 - 73.6), right bundle branch block (OR 22.5, 95% CI 2.62 - 242), first-degree atrioventricular block (OR 18.8, 95% CI 3.04 - 150), and implantation depth measured via echocardiography (OR 1.76, 95% CI 1.26 - 2.64). The model demonstrated good predictive capability with an area under the receiver operating characteristic curve of 0.934 (P < 0.001, 95% CI 0.878 - 0.988).

Conclusion: A well-performing predictive model was developed with six independent risk factors for the need for pacemaker implantation after TAVR, based on factors related to anatomic echocardiographic measurements associated with classic risk factors.