Predictors for permanent pacemaker implantation following Transcatheter Aortic Valve Implantation: Trends over the past decade

Objectives: This study sought to identify risk factors for permanent pacemaker implantation (PPI) after Trans-catheter Aortic Valve Implantation (TAVI) and explain their trends over the last decade.

Background: TAVI is performed nowadays for severe aortic stenosis in more patients with lower surgical risk. While most TAVI complications have been reduced, PPI remains common.

Methods: In this observational, retrospective cohort analyses, 339 TAVI patients treated between 2008 and 2017 were reviewed. Risk factors were compared between the early (2008-2013) and late years (2014-2017), and a multivariate logistic regression model was used to identify independent risk factors for PPI.

Results: A decreasing trend in PPI over time was observed (p for trend = 0.008), as was a lower rate of PPI in the late period (19.3% vs. 31.7%, p = 0.009).

Three variables were identified as independent risk factors for PPI that also decreased significantly in the late period: Valve implantation depth ≥ 8mm (OR=4.3, 95% CI 2.3-8.2, p<0.001), use of self-expandable valves (OR=2.8, 95% CI 1.4-5.5, p = 0.004), and patient risk assessed by Euroscore2 (OR=1.07, 95% CI 1.0-1.1, p=0.034).

Indications for PPI were also shown to change over time, with an increase in complete AVB as the main indication (p = 0.048), and a trend towards a decrease in LBBB alone (p = 0.061).

Conclusions: The decrease in post-TAVI PPI over the past decade is multifactorial and can be explained by 1) lower patient surgical risk at baseline 2) modified procedural variables including decreased implantation depth and increased use of balloon-expandable valves, and 3) refined indications for PPI.