Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Predictors associated with permanent pacemaker implantation in patients receiving a ballon-expandable transcatheter aortic valve prosthesis - results of international prospective multicentre registry

M. Droppa1, T. K. Rudolph2, J. Baan3, N.-E. Nielsen4, J. Baranowski4, P. Bramlage5, K. Bramlage5, J. Kurucova6, T. Geisler7

1Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Tübingen, Tübingen; 2Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 3Heart Center, Academic Medical Center, Amsterdam University, Amsterdam, NL; 4Department of Cardiology, Linköping University Hospital, Linköping, SE; 5Dr. Bramlage & Dr. Hankowitz Partnerschaft, Institut für Pharmakologie und präventive Medizin, Mahlow; 6Edwards Lifesciences, Prague, CZ; 7Innere Medizin III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Tübingen;

Background: Permanent pacemaker implantation (PPI) occur in about 5-20% of patients after transcatheter aortic valve replacement (TAVR). Several risk factor for PPI were identified in small single centre registries. We initiated prospective multicentre registry (CONDUT pro) to evaluate patient- and procedure related variables assotiated with PPI in larger patients’ population. Methods: Prospective registry CONDUCT pro recruited patients with high-risk for PPI after TAVR with ballon-expandable prosthesis in four european high-volume centres (Germany (2), Sweden (1), The Netherlands (1)). Baseline clinical characteristics, ECG conduction abnormalities, CT-scans (calcification, annulus size) and procedure related variables (valve oversizing, implantation depth) were analysed. Result: A total of 270 patients were enrolled. There were 36 patients (13.3%) requiring PPI after TAVR. Comparing patients with vs. without need of pacemaker implantation, elongated QRS duration (77.8 vs. 53.8%; p=0.007), complete right bundle branch block (69.4 vs. 18.0%; p<0.001) and no sinus rhythm (36.1 vs. 19.3%; p=0.023) prior TAVR were significantly associated with the implantation of a permanent pacemaker. Significantly more patients with need for PPI received a SAPIEN S3 - instead of a SAPIEN S3 Ultra prosthesis (88.6 vs. 71.4%; p=0.031). Bigger prosthesis was also associated with PPI (27.3 ± 2.2 vs. 26.6 ± 2.1mm; p=0.028). Mean implantation depth (5.5 mm vs. 5.3 mm, P=0.49) and valve oversizing (20.7% vs. 12%, P=0.24) did not differ significantly between the two groups. Length of stay in-hospital and on intensive care unit was longer in patients receiving a pacemaker post TAVR (9.5 vs 5.1 days; p<0.001 and 2.0 vs. 0.1 days; p<0.001). Outcomes were comparable at discharge and at 30 day follow-up except for life- threatening bleeding occurring more often among patients with permanent pacemaker implantation (5.6 vs. 0.4%; p=0.049 at discharge). Conclusions: A number of variables in this population of patients at high risk for pacemaker implantation after TAVR, some of which have already been recognized in the past, were identified and confirmed. This knowledge might contribute to a better pre- and post-procedural patient management to improve patient outcome.

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